On 10 June 2007, Carmen Tarleton, then 38, was at home with her young daughters in Thetford, Vermont in the US, when her estranged husband broke into the house. Herbert Rogers was looking for a man he supposed she was seeing, but finding no man there, he attacked Carmen. “I just lost it,” he told police later. He beat Carmen with a baseball bat so violently that he broke her arm and eye socket. Then he doused her in industrial-strength lye – a sodium hydroxide solution used in cleaning. One ear, her eyelids and much of her face was burned away. She suffered burns on 80% of her body.
I met Bohdan Pomohač, one of her surgeons, at Boston’s Brigham and Women’s Hospital. “In terms of injuries inflicted by another human being, it’s certainly one of the worst I’ve ever seen,” he told me. Her face was almost completely destroyed; her family were able to recognise it was Carmen only by her teeth.
When people experience terrible head injuries, doctors can put them into a barbiturate coma in order to shut down brain function. This prevents the brain from damaging itself further by trying to keep going without an adequate blood supply.
Carmen remained in a coma for three months while Pomohač and his team performed 38 separate surgical operations. She was left covered in a patchwork of skin grafts, and these, together with all the blood transfusions she had received over the months, meant that she had become immunologically vaccinated against at least 98% of the population. She was blind, severely disfigured, and lacked many normal facial functions. She was in a lot of pain. But she was alive, and somehow, somewhere, the germ of something remained within her.
“Even when I first woke up from the coma I just knew it was such a big event, and it was so strange, that it had other meanings for me,” she says. “I could help a lot of people.”
Carmen started doing inspirational speaking. “I looked terrible and people felt so sorry for me, but I wanted to show people it didn’t matter what I looked like,” she says. Photos of Carmen from that time are shocking; with all the grafts, she didn’t have proper eyelids, and her eyeballs looked out through small circular holes cut into the skin. She had synthetic corneas and couldn’t blink, and the edges of the skin were red raw.
“It forced me to look at the big picture of what life is really about,” she says. “And that’s where I’ve had to go, because this horrific event occurred and I found a way through it. And not because I’m different or special, but because that’s what was meant to be: to show people you can be involved in these incredible events and you can forgive, totally, and move on.”
She says she has forgiven her now-ex husband for what he did. (In return for pleading guilty to maiming, he accepted a sentence of 30 to 70 years in prison. He died in prison in December 2017.) “I was never religious,” she says. “I took responsibility for my life. I was not responsible for what happened, for what he chose to do, but I certainly was responsible from that day forward.”
Even after leaving hospital, Carmen was still in a lot of pain. The injuries to her skin and the multiple grafts caused tightness when they healed, and this led to all sorts of secondary problems with the mobility of her neck and spine. Still she kept going.
Then, on Valentine’s Day 2013, Carmen’s life changed again. She became only the seventh American to undergo a complete face transplant. The operation was performed by Pomohač.
Pomohač says that for a long time he didn’t think of Carmen as a candidate for face transplant, because she was so immunologically challenged. All those grafts and transfusions had primed her body to attack almost any donated tissue. But there were several pressing reasons why she needed a new face. The pain and the narcotics, yes, but as well as that, the opening on to her eyeball was getting bigger, and this was threatening the integrity of the synthetic cornea. Then there was the drooling, and the problems with speaking and eating.
It’s possible there is a psychological force that carries people through … Sometimes people can surprise you with their resilience
The operation was a technical success, but then there was the immune system to deal with. Carmen’s body mounted a massive rejection of the face and, for a period of four weeks after the operation, she was pumped up on numerous immunosuppressants. By then there was only one more drug left to use. A full dose would help suppress the rejection, but would also completely wipe out her immune system, to such an extent that any trivial infection would kill her. In the end, with Carmen’s consent, they gave her a little of that final drug; it was enough to tame her immune system. She got better. Carmen says she felt she had made a choice to live.
“It’s possible there is a psychological force that carries people through, but my official answer has to be that the statistics were still a little bit in our favour,” says Pomohač. “Sometimes people can surprise you with their resilience.”
Carmen suffered physical injuries that could easily have killed her. That she survived is remarkable in itself, but what seems even more incredible is how she has not just survived mentally, but developed into someone else – someone who, by her own account, is better.
Before, she was a registered nurse and was raising children, and, until her incident, she had not thought about the big questions of life: “I wasn’t going to sit around and complain and cry.” Carmen now says she wouldn’t go back and change what happened: she has grown too much. It is a pattern seen in others who have suffered an incredible trauma, and found a way through it.
How do they do it? For physical trauma, it is not so mysterious that some people survive. As Pomohač says, statistically, some people will just make it through. When they do, we are so surprised that we fixate on it, and may even call it miraculous. We remember these people, the extraordinary survivors such as Gabrielle Giffords, and we don’t just shrug and say, “Well, it’s not impossible to survive even being shot in the head.” Statistics aside, medical care is good and the body is capable of amazing repair – perhaps better than we might give it credit for.
But it is the mental resilience that is sometimes more impressive. Carmen tells me that we get too caught up in negativity. You’ve got to take control, and make your own choices. “I don’t live like the typical person on the inside at all,” she says. “I have different beliefs that help me go when I’m going.”
Some people can ride out trauma and even prosper, when others suffer lingering physiological stress and fear – the hallmarks of post-traumatic stress disorder. Psychiatrist David Wolfe is head of outpatient services at the evocatively named Building of Transformative Medicine at Brigham and Women’s Hospital. The funny thing, he tells me, is that the people who suffer trauma but actually come out better aren’t the people who are studied. If someone is coping well, they are sent home. Psychiatrists see the people who struggle. But perhaps, he says, people don’t suffer as much as we think.
“Psychiatry has been as guilty of this as anyone. You assume that, if something bad happens to someone, they’re going to have some mental problem. It happens when we see patients in hospital with very serious diseases. We think: ‘They must be depressed – wouldn’t you be?’ But, actually, they’re not.”
That is not to say, of course, that people don’t suffer and don’t need treatment. According to the United States National Center for PTSD, seven or eight out of every 100 people will experience PTSD at some point in their lives. What Wolfe is saying is that it is wrong to assume a traumatic event will be the same for everyone. More often than not it’s more impressive how well people cope with trauma, which makes sense from an evolutionary point of view: it is advantageous to have hidden powers of resilience. “The ability to power through adverse conditions should be there in our DNA,” Wolfe says. “It’s more of a puzzle why, from an evolutionary standpoint, we have problems with that sometimes.”
No one does things like this alone, without the friends and family who rally round. Your social network is key to how you deal with trauma. “People who respond well tend to have positive relationships in their life and that translates into positive relationships with their treatment teams,” says Wolfe.
One of Carmen’s sisters moved to Boston so she could see her every day while she recovered, even before she came out of the coma. When Carmen left hospital, years before the face transplant, she went to her family. She saw a therapist for a while after she was attacked, but she says her experience was so far off the chart that nobody knew what to say to her. “I cried at my sister’s and my mother’s and bitched a little, and after a year and a half I thought, that’s not going to help me.”
I needed to find a way through this … My biggest motivation was that I wanted to be a role model to my daughters
Optimism, not surprisingly, is one of the character traits shared by people who respond well to trauma. “The opposite is hopelessness, which is a feature of depression,” says Wolfe. “Engagement, taking it on, taking on responsibility, and being active in the process – these things go a long way.”
When you ask people what keeps them going, Wolfe says, the number one answer is family and kids. People who are resilient look to the future. Carmen had a clear goal: “I needed to find a way through this, because I wasn’t going to go anywhere. I was raising children, there were things I wanted to do. My biggest motivation was that I wanted to be a role model to my daughters.”
What about the genetics of resilience? Even when we find genes related to disease, it rarely works on the basis that “you have the gene, you’ll get the disease”. Sure, there are instances, such as familial Alzheimer’s or cystic fibrosis, where this is almost always the case, but most diseases, and almost all traits, are far more complex, and are influenced by many genes. Resilience is one such complex trait.
Ann Masten, a psychologist at the Center for Neurobehavioral Development at the University of Minnesota, Minneapolis, calls the power of resilience “ordinary magic”. It is magic that anyone can use. Nimmi Hutnik, author of Becoming Resilient: Cognitive Behaviour Therapy to Transform Your Life, says resilience – although a complex mix of biology, psychology and environment – has the potential to be taught. Pharmaceutical interventions to extend healthspan are being developed, but until then, it is worth noting that exercises in mental resilience can be learned, and can be used to promote health and wellbeing.
The capacity to be super-resilient may be there even in normal people, but we need guidance and support to find it, maybe from psychotherapy, maybe from friends. We need help to be optimistic, encouragement to take control, and empowerment to be responsible. We need a certain amount of self-love. A touch of narcissism is good. We need to stand up for ourselves so we are not mistreated at work or in relationships, we need to be assertive without devaluing others and have a self-image that is positive without being conceited. This mixture of personality traits will drive you forward. And, if you do not have them naturally, some of them can be constructed.
Extracted from Superhuman: Life at the Extremes of Mental and Physical Ability by Rowan Hooper, published by Little, Brown on 3 May, price £14.99 (rrp). To order one for £12.74, go to guardianbookshop.com. Free UK p&p on orders over £10.00.