Resilience – life’s bounce back

Resilience is one of the sexiest topics in psychological research at the moment. That property which enables one to bounce back after hardship or trauma. Researchers have tried to examine why some are broken by trauma and why some do better than survive, they flourish.

The prior models of “grit and determination” helped previous generations endure difficult times; think of the stiff upper lip British in WW2.  It also has the dark side of people toughing out toxic situations, like an abusive marriage or work situation. Nowadays, a more transcendental model is being put forth. Resilience now not only means enduring suffering, but it also refers to flourishing through adversity.

Victor Frankl, the Jewish psychiatrist who survived a concentration camp, said that what matters is what life expects of us. Living a life of meaning can help one survive the most heinous atrocities. He said: “those who have a ‘why’ to live, can bear almost any ‘how'”.

Dr Greg Steinberg interviewed people who seem to have flourished through trauma.  He feels that the old science of loss (as first described by Dr Kubler-Ross), with stages of denial, anger, bargaining, depression and acceptance, is incomplete. That there is another process some people undergo whereby adversity can become an advantage.

The people whom he interviewed all went through the same process of describing their tragedy as a “wakeup call”. Like Victor Frankl years before, they found that the terrible moment had a purpose. Through their pain, they connected with their life’s  purpose. Dr Steinberg goes on to say that transcendence happens when the sufferer then finds a way to give back.

We have all heard such stories. Amy Biehl’s parents lost their child to Apartheid violence They then started the Amy Biehl Foundation to help empower township youth. The recent murder of beautiful Hannah Cornelius left her parents brutalised. Their pain has driven them to connect with other parents who have lost their children to violent crime, and they have launched the Hannah Cornelius Foundation to that end.

Buddha said life is suffering. More specifically, he said, life is dukkha. Dukkha is a difficult concept for a Westerner to understand. It means suffering, imperfection, anguish, dissatisfaction. It also means to have one’s joint wrenched out of its socket. We don’t like to think about it, but it’s true. Sooner or later, we all get “wrenched out” by life.

Most times life’s traumas make us a little kinder and more compassionate. We become wiser, more aware of transience, more grateful for our blessings. It’s all part of mankind’s terminal condition.

Sometimes it doesn’t quite work like that. Sometimes the trauma is more than one can bear. Sometimes we are hit at a time when we are most vulnerable. When we are exposed to a trauma our body’s homeostatic mechanisms go out of whack, freezing us in a state of fear and hyperarousal. With repeated traumas, even the most resilient of us can get depleted.

My practice has several patients who re-live their traumas over and over again. It’s a clinical condition called PTSD (post traumatic stress disorder), and medication is often an important part of recovery. Some of my patients had traumas which hurt them so much that they built defences around themselves. Defences so effective, they freeze them, making it hard to love or be joyful. Chronic stress and repeated traumas, especially in childhood, can change the brain’s structure, making the sufferer more prone to mental disorders.

To strive for a purpose in pain, to try to transcend trauma and give back, is very noble. If it inspires you, go for it. As a psychiatrist working with hurt people, I was trained to look for “protective factors”. It is my experience that patients want to heal, and it’s part of a psychiatrist’s job to help connect them with their strengths. Not quite as glamorous as bouncing back or transcending, but resilient nonetheless. And its resilience we can all cultivate. Some protective factors I’m always on the look-out for include:

• Social connectedness. To South Africans the concept of Ubuntu is so important: “I am what I am because of what we are”. To do something for someone else, even if that something is simply surviving. I spent a lot of time looking for connectedness in my patients’ histories. That’s partially why I ask so many questions about families and relationships. Social connection can carry a person through pain. If you have love, you are going to be okay.
• We can nurture our resilience by reconnecting with our values. For some, like Victor Frankl, it is to find one’s purpose in life. For others, it is a more profound connection with their faith; a surrendering to a higher power. In an interview with a patient, I listen for words like gratitude, blessings, humility, hope.
• In many ways, the response to trauma is as physical as it is psychological. The body goes into fight or flight mode. If it stays in that mode for too long, symptoms such as aches and pains, heart palpitations, stomach problems, low immunity and sleep problems are common. Many people try to self-medicate these symptoms with drugs, alcohol or overeating, which temporarily numbs these sensations. This then creates other problems and maintains the trauma response, not reduces it. A more effective way to increase resilience would be to pay special attention to self-care. Exercise can use up adrenalin (the fight or flight hormone) and release endorphins (feel-good hormones). Eating properly ensures that the building blocks are there to heal. It is not how we endure the trauma, its how we refuel that helps us get strong again.
• Another protective factor is a sense of humour, or silliness. A patient who can chuckle at themselves tends not to take everything so seriously and is more connected with the transience of the situation. “Gallows humour” is when we can be witty in a hopeless situation.

Suffering is inevitable. Resilience is  occasionally glamorous; mostly it is hard work. If we have love in our hearts for those who suffer, we all become stronger.

“We only have what we give.” – Isabel Allende