Trying to define "resilience"

I think before I go any further with this idea, it might be important to define what resilience actually is.

Unfortunately, as is the case with many words in the medical literature, resilience has too many meanings and consequently, its hard to get a handle on.

When defined by the basic sciences, resilience is used to describe how well a material can return the energy that is put into it. In other words, it is a measurement of how well an object can return to its original state after it has been deformed -- how springy is a spring. When used in biology, it takes on additional meanings. In cell biology it refers to the ability of a cell or a community of cells to recover from a disruption introduced into their environment. This can be extrapolated to other living communities. For example, we're currently very concerned about the resilience of fragile ecosystems as they are confronted by global climate change.  Will these plants and animals be able to adapt to the changing environment?

When talking about human beings the word resilience takes on a lot of not-so-clear definitions. As it relates to the individual, a topic that I'll try to explain in the next few paragraphs, we talk about psychological resilience, familial resilience, community resilience (i.e. how well did New York recover after September 11th), physical/sports resilience (how quickly does Raphael Nadal's confidence recover after a lost point) and organizational resilience (how well does a business adapt to changes in the environment). Given that I know little about most of these topics, I'll stick to psychological resilience for the time being.

The definition of psychological resilience is not so straight forward either. The term has become a topic of research in three major areas of medicine:

1. Trauma and disaster intervention
2. At risk youth and decision making
3. The effect of medical illnesses (i.e. cancer) on mental well being

Each research domain defines resilience slightly differently based on unique research methodology considerations. Even so, there are similarities that I'd like to touch on for the rest of this post.




First, in all three of the instances above, resilience is multifaceted. This definition characterizes a unique interplay between an individual's psychological, physiological and psycho-social state, their previous encounters with environmental challenges (their perception of the event) and vulnerabilities that come into play at the moment when a stressor is introduced. A schematic of this interplay is shown above. This particular image forms one of the theoretical foundations for clinical liaison psychiatry and includes within it something called "Allostasis" that I'll address in the future.

Second, resilience is considered to be a complex dynamic process that can change from minute to minute. This is very different from other definitions where the resilience of a system is more or less static. Imagine a person, Francis, responding to a traffic accident. Within moments of seeing the accident happen, Francis has a complex interplay of emotions, physiological reactions and thoughts that would emerge predicting whether she would respond to the accident or run away. Now imagine that the person who was in the accident was Fran's friend, or that she was standing next to her favorite teacher who happened to be a very calm person. This would allow for a different response to the stressor and possibly a different psychological outcome in the end. One of the best examples of this comes from literature emerging from cancer psychiatry in children. The best predictor for how well a child does in the face of illness has to do with their parents' proximity and response to their condition. More on this later.

Third, in any given situation, resilience is a recursive process where over the course of the effect of the stressor, a person has the ability to learn and adapt or become more vulnerable. If Francis were to run away from the accident, she would feel guilty, and potentially even more stressed than if she had gone to help. Alternatively, if she had gone to help and overcome the emotional, physiological and psychological barriers to her doing so, she would, in that moment, begin a process where she potentially felt stronger and more resilient then and in future events.

Finally, and most importantly for this blog, resilience is something that can be actively modified prior to, during and following a stressful event. There are things that any person can learn to do that will help him or her cope better with stress and rebound more successfully. Many of these factors are learned throughout life; self-talk, suppression, humor, mindfulness and distraction are a few skills that seem to emerge from cultural and evolutionary wisdom. Nonetheless, there are skills that can be honed and techniques that can be learned that can help people deal with the daily (or more severe) stresses in their lives.