BY DR. MARK PETTUS, MD
“. . . everything can be taken from a person but one thing: the last of the human freedoms . . . to choose one’s attitude in any given set of circumstances, to choose one’s own way.”
— Viktor Frankl
As certain as taxes and death, we can anticipate adversity in our lives. The pandemic has reinforced that thought, unfortunately. No one is sheltered from the vulnerability of being human. Resilience is the process of adapting well in the face of such adversity. When it comes to health, quality of life and longevity, a person’s capacity for resilience is where the rubber meets the road.
Research has shown that resilience is ordinary, not extraordinary, meaning that people commonly demonstrate the capacity for resilience. This has been my own experience, that of family and friends, and the experience of many of my patients and their families as we confront major setbacks in our lives. We all experience pain and adversity in our lives e.g. losing a loved one, confronting illness and diminished quality of life, traumatic events, divorce, etc.
We also experience a host of less traumatic setbacks in our lives such as losing a job or promotion, struggling to make ends meet financially, maintaining our relationships, and dealing with health issues. Of course each one of these is relative and all about the context of what else is happening in our lives and how we are coping.
How we “bounce back” in response to the difficult experiences in our lives is what resilience is all about. So why is it that some people just seem to cope better in response to life’s obstacles? Is resilience a trait you’re born with? Can resilience be cultivated? What do we currently understand about the nature and nurture contribution in connection to the capacity for resilience? What do we understand about the biological underpinnings that distinguish vulnerability from resilience? Lastly, can resilience be taught, and if so, what are some paths to getting there?
Evidence suggests that children begin to learn and develop resiliency skills at a young age. Emmy Werner, a professor of human development at the University of California at Davis, has researched resilience in children and found that the strength of the parental bond, particularly in those pre-K years, is a crucial determinant of effective adult adaptation.
Developing capacity around a particular strength like reading or drawing assists children with a foundation to build upon and to fall back on when confronting increased stress. Belief in something one can reach for that has personal meaning attached, e.g., “becoming a dancer or an architect one day” or connection to sources of meaning and purpose e.g. one’s spirituality, can serve as a rudder when the water gets choppy and the winds unpredictable. Improved health outcomes are more often seen in such individuals.
Not surprisingly, emotional trauma, childhood and adult experiences of violence and abuse, lack of education, and dysfunctional non-loving relationships weaken resilience capacity. Poor health outcomes predictably emerge from such a place.
The abundance of available research that informs our understanding of resilience using tools to measure resilience capacity, the relationship between resilience capacity and health outcomes, and the human attributes that are most consistently associated with resilience demonstrates the following:
Relationships are a critical dimension woven throughout the fabric of a resilient individual’s life. Having caring and supportive relationships at home, work and play is an important factor. Relationships defined by love, trust, encouragement and support foster an individual’s capacity for resilience.
Meaning matters. Much has been said about the healing potential unleashed with purposeful pursuit of meaning in love, work and play. Individuals who identify and develop such areas in their lives naturally cultivate a lush garden of personal meaning to fall back on as a source of strength and optimism. These characteristics are essential in the development of resilience. In the same way, values like friendship and academic and athletic skills become motivators with the reward in the satisfaction of those values. For resilient individuals, sources of meaning and personal strength serve as a beacon guiding them through the most challenging storms.
Resilience research suggests the following strengths as critical to the capacity to bounce back from adversity:
Self-awareness: Individuals who demonstrate greater capacity for resilience in their lives have developed a strong sense of who they are and greater confidence in their strengths and abilities. Kids, for example, who find something they can do better than anyone else are more likely to transcend obstacles in life. Adults who can “gut check” are better able to link behavioral choices with consequences, are more mindful of their inner compass, and are more likely to bounce back. Developing a sense of self-worth is a vital dimension to this perceptual awareness.
Emotional Management: Resilience requires the skills and capacity to manage strong feelings and impulses. I’ve been strongly influenced in my own “resilience development” endeavors by the work of Daniel Goleman and others in the field of emotional intelligence. These critical competencies are skills that enable resilience in every aspect of life. In addition to self-awareness, self-management competencies are very important. Goleman elaborates on skill development in areas of:
• Emotional self-control — keeping disruptive impulses under control
• Transparency — displaying honesty and trustworthiness
• Adaptability— easily adjusting to changing conditions
• Initiative — readiness to mobilize the courage to act and seize opportunities
• Achievement — the desire to satisfy values
• Optimism — developing positive perceptual frames for examining circumstances.
Selfless Acts: Children and adults who are more likely to rebound have had experiences of helping others in need. Serving others enhances one’s capacity when confronting a crisis to better serve oneself. Our own experiences are placed in a broader context when we’re aware of the needs of others and that we’re not alone in our vulnerability. Virtues of generosity, gratitude, empathy, forgiveness and altruism are commonly seen in people who exemplify resilience.
Skills in Communication and Problem Solving: Awareness and communication of needs, beliefs and expectations are necessary skills as you navigate your lifeboat of resilience through choppy seas. Developing skills in conflict management and problem solving add substantial buoyancy to the vessel you’re navigating. Many of the setbacks we confront in our lives center on interpersonal conflict. The stakes are often high with respect to the quality of our lives. Resilient individuals understand that survival, at some level, requires preservation of vital relationships and an ability to communicate and work through differences.
Good Health: Individuals who enjoy better health are more likely to bounce back from adversity. While good health alone is not a guarantee for resilience, individuals with poor health are more likely to be rendered vulnerable in response to stressful setbacks. You’ll also note that the characteristics that form a foundation for resilience are, in themselves, health promoting!
The evidence is clear, as is true for virtually all aspects of our lives — work, home and community. Resilience capacity is less likely to be something we are born with and more likely something we nurture and develop throughout our lives. Acts of resilience are not rare at all.
Humans are in fact designed for resilience. And even when the obstacles may seem insurmountable, as Victor Frankl reminds us — there are some things that cannot be taken from us — “the last of the human freedoms … to choose one’s own way.”
DR. MARK , MD, FACP, ABOIM, is the chief medical officer at Preventia. He is a triple-board certified internist, nephrologist and integrative medicine physician practicing for over 25 years. He received his M.D. from the University of Massachusetts Medical School with postdoctoral training from Harvard Medical School. He previously served as the director of Medical Education, Wellness and Population Health at Berkshire Health Systems in Western Massachusetts. In addition, he served as the associate dean of Medical Education at the University of Massachusetts Medical School. Dr. Pettus is the physician lead on population health initiatives for Western Massachusetts and currently serves as president of the National Wellness Institute Board of Directors. He is the author of two books, “The Savvy Patient: The Ultimate Advocate for Quality Health Care” and “It’s All in Your Head: Change Your Mind, Change Your Health.” Dr. Pettus has appeared on numerous TV and radio venues nationally including the 700 Club, Good Morning America, NPR and PBS. His podcast,“The Health Edge” is heard by people all over the world.