The days that we only focus on pathology after trauma are long gone. In the past two decades, the literature that adopts a ‘well being’ rather than a ‘deficit’ model has grown substantially. In 1990, the field had published 4 English papers on resilience. Today, there are 858.1
But what is resilience? And how do we become more resilient? The topic is not without controversy. In a panel session at the ISTSS conference, profs Rachel Yehuda, George Bonanno, Ann Masten, and Catherine Panter-Brick gave their views. Here is what I took home:
What is resilience?
- It is a trajectory. Bonanno identifies two resilient trajectories: one in which survivors of trauma do virtually not experience traumatic stress (‘minimal impact‘) and one in which they experience initial distress followed by a steady recovery (‘emergent resilience‘).
- It is the capacity to continue functioning and move forward. In Yehuda’s view it’s important to focus on to what extent symptoms affect functioning in daily life. She referred to the slogan Timex used to promote the robustness of their watches: “It takes a licking and keeps on ticking”.
- It is the capacity of dynamic systems to adapt to disturbances. According to Masten a definition should be applicable across disciplines and situations (i.e. from engineering to economics to emergencies). She painted the picture of a group of refugees who, despite flare ups in PTSD, were resilient.
- It is the process of harnessing resources to sustain well-being. Panter-Brick argued that the field suffers from 3 deadly sins: it has hazy definitions, is empirically light, and methodologically lame. In her view, resilience is ultimately a question of harnessing resources.
What makes some people more resilient than others?
According to Bonanno, there are 5 categories of factors that predict resilience: 1) demographics, 2) economic resources, 3) social resources, 4) personality, and 5) biological factors. No single variable carries much of the variance; they are all small pieces of the puzzle. Masten homed in on the third category and stressed that resilience is interdependent: social capital is crucial.
Can the capacity for resilience be enhanced or taught?
- Rather than trying to enhance resilience we should try not to undermine it. There isn’t a right way to cope. It’s about flexibility; how you cope depends on the situation (Bonanno).
- We need to ensure people’s dignity. This could be done through providing jobs and social stability rather than a pure focus on mental health (Panter-Brick).
- We need to support the healthy development of children; we need to develop their capacity (Masten).
- We need to practice: we now wait for trauma to happen before we organise interventions. We don’t prepare well enough (Yehuda).
No definitive answers yet but food for thought for sure!
1Based on counts in the PILOTS (Published International Literature in Traumatic Stress) database. Note: of course this is my reflection of this debate; corrections/additions are welcome!