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The Problem with the Word Resilience

 

I recoil when I hear the word resilient. It makes me cringe and I don't always understand why.

I've been thinking really hard about this topic for two reasons. 1. The word is used all of the time. 2.I'm working on a story about resilience.

I'm not trying to convince anyone not to use the word resilient. I just want to share why it is a hot button word for some.

Yesterday, I found an example that helps me put this into words.

I was reviewing a fascinating study done in 2011 on 746 Danish soldiers which showed that pre-deployment trauma, not combat experience, is the crucial factor differentiating the soldiers who get PTSD from those who do not.

It's a fascinating study.

I learned about it via a webinar, "Childhood Adversity and Toxic Stress in Medical Care: Promoting Health and Healing Throughout the Lifespan," given by Dr. Beth Grady, who is a member of this network. 

Anyhow, the study itself is interesting as PTSD is still thought of by many as something only veterans get. Of course, that's not true. Plenty of civilians get it from wars fought in the home by children trying to survive childhood who have high ACEs and/or adverse community experiences.

This particular study is unique because it looks at pre-deployment stress and measures PTSD symptoms before, during and three times in the first eight months after soldiers arrive home from a six-month service in Afghanistan.

Back to the word resilient, though. 

It's used a lot in this study. There are two groups, which make up the 84% who have little or no symptoms of PTSD before, during or after deployment. They are termed the super-resilient and the resilient.

They are also the ones who have not experienced pre-deployment traumatic stress.  

The "non-resilient" are the ones with PTSD symptoms before, during or after deployment.

Those with the "non-resilient trajectories" are the ones with a history of pre-deployment trauma, most especially from childhood adversity.

So often, in the medical community and in general culture as well, those who have symptoms from trauma are considered non-resilient and those without symptoms are considered resilient.

I don't understand why this word is used to describe people.

I don't understand why we can't use words that celebrate the protection that a lack of trauma offer soldiers. Indeed, isn't that a reflection of low ACEs, good luck and good fortune, rather than resilience?

I understand, that for many, resilience is about protective factors in communities. But often, and painfully, people are considered non-resilient when having symptoms of PTSD and those without are considered resilient.

This is what, for many of us, feels minimizing.

The soldiers who do not get PTSD are considered "robust" and one article describes them this way.

"They are a resistant group, and do not allow themselves to be affected by their everyday situation either before their posting, during their tour in Afghanistan or after returning home."

It's not just that differences in symptoms are being assessed but that the word choices reflect bias and judgment.

But more, they don't take into account what Jane wrote about so eloquently yesterday:

"Talking about ACEs normalizes the experiences of childhood adversity, brings them to light, and shows time and again how we’re all swimming in the same ACEs ocean, how we’re all breathing the same ACEs air."

I think this study could be used to show how protective a low ACE score might be and how a higher one is associated with more risks. We all have an ACE score. We are all impacted, in positive or negative ways, by that score.

Ideally, understanding this is good for all of us. It de-stigmatizes those with symptoms and high scores and motivates us all to have a society filled with children with lower ACE scores.

But instead, the tone of the article is different and it's a tone present and palpable for many of us. 

A tone that forgets or fails to see that absence of early adversity isn't robustness. Absence of pre-deployment traumatic stress is wonderfully protective, but it doesn't make an individual resilient in the way the word is used: as a compliment rather than a condition or a fact.

I think that's what so many of us who recoil at the word resilient.

My boyfriend is a techie and we were recently talking about resilience. He is confused by it as well, but not for the same reasons as I am. He always asks if it's about a system or a person because in computer networking it means this:

"the ability to provide and maintain an acceptable level of service in the face of faults and challenges to normal operation."

Isn't someone with pre-deployment stress, with a history of trauma in childhood, who still serves in Afghanistan for six months, even if they get symptoms, resilient?

I think they are. Isn't that resilient? 

I don't think symptomatic should mean non-resilient.

Or resilient.

Those with low ACEs have "symptoms" of good health. They are symptomatic too. But often, their lack of symptoms are treated as personal strength or character. Or even as a set point.

This is the part of the seesaw I think we sit on long and hard enough. We don't appreciate how much better those with low ACEs often fair. It's not just that high ACEs come with risks but that low ACEs offer great rewards.

We can use ACEs science for the benefit of us all.

All I know about ACEs helps me feel compassion for myself and my parents, because of our high ACE scores. Simultaneously, it motivates the heck out of my parenting because I don't want my daughter to inherit this score. I want her to have symptoms of a low ACE score.

Better health. 

I think it's wonderful that so many soldiers have not developed PTSD. That's great. I also think they should be aware, when facing future trauma, that they are at greater risk. And if symptoms emerge, for them, it's not because they stopped being resilient but because they may be overburdened by toxic stress.

It makes them human.

I think we have to be careful with when and how we use the word resilient. It's often used to describe circumstances, conditions and individual personality traits and character.

For many of us with a history of high ACEs, we've been told that our symptoms are optional, and that if we were more resilient, we would suffer less, be burdened less, would or could struggle less as though resilience is a cup in out reach that we refuse to reach for, drink from and fill.

That's why many of us love learning about ACEs. We see that actually, our symptoms are almost predictable, that others, with scores similar to ours have struggles similar to ours. It's actually not as personal as we've thought. It's less a personal problem and more a social issue. This can be empowering, in our healing as well as our activism efforts.

I know we need to understand what protects people, what we can do to prevent PTSD and pain as well as how to recover from it. I just hate when the focus on resilience seems like another way to minimize causes of suffering rather than understanding symptoms as responses.

Resilient is a word that can polarize instead of unify us. Many of us have felt badly that we aren't more resilient  we didn't understand that almost any human, with a high or low ACE score, has some predictable outcomes, no matter their individual quirks or personality style.

Trauma, even that happened in the past, impacts us in the present. That's true for the 746 Danish soldiers. 

Our ACE scores, high or low, impact us all the time.

That's true for all of us.

It doesn't mean we are powerless but it's not as though we could have chosen to be resilient and failed to make that choice.

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The research of the Transcending Trauma project on Holocaust survivors and their families found that the prewar lives of the survivors impacted their coping and adaptation postwar/post trauma. Specifically, TTP found that the quality of the survivors’ family relationships prewar impacted their individual coping styles in the postwar period. Survivors who became parents, or had children before the war, affected the development of their children’s identity and values through story-telling of “trauma narratives” about their experiences. How these narratives and other family events affected the children was determined by the qualitative experience of family relationships. Many families were able to mitigate negative impacts of emotional distress and raise children who felt they lived normal lives. For more about TTP's findings see http://ttp.councilforrelationships.org/ttp-findings/ 

We teach these findings to our clinicians and interns and other professionals in the Philadelphia region who work with Veterans and their families as part of our training courses on military culture and best practices. 

Kathy:

I know there are lots of us and it's not always easy to articulate why, at least for me. If you've written on this, please link to it as i always love to read your words!

Cissy

Patrick:
Thanks for the link and comment and reminder that exercise is helpful! I mean I know that, generally, but also in how it's a way to get positive chemicals flushing as well as helping to avoid ways that do similar things but with greater health risks/threats/consequences.
Cissy
 
Darby Penney posted:

Thank you so much for writing about this.  It feels like the authors of the Danish study (hopefully unintentionally) mis-used the term "resilient" in such a way that it sounds like a value judgment and blames those who had trauma exposure prior to their military service. That's really problematic. The issue of childhood exposure to trauma as a risk factor for PTSD for combat veterans is an issue that bears more study.  I was part of a team that evaluated a federally funded multi-site jail diversion program for veterans who were trauma survivors, and virtually all of the participants had exposure to traumatic events before the age of 18 as well as during their military service. 

Darby:
I think those who did the study did a great thing by bringing attention to childhood adversity and pre-deployment PTS. But yeah, the language left a lot to be desired as it does seem to have lots of judgment and bias (though I can't imagine it's intentional). I'm glad, as in the work you've done, that we're looking more at what has happened to people earlier in their (our) lives and looking at the impact. Cissy

Wendie Skala posted:

Thank you for your response to the word resiliency. As a military officer I have been deployed 8 times in support of Operation Enduring Freedom-four tours in Afghanistan. Since my last deployment three years ago,my life has been difficult and I have had both physical and psychological manifestations of toxic stress. I thought I was so resilient and had overcome my ACEs score of 7. I was wrong. Your response shined the light on how my resilience has allowed me to succeed in my military career but my ACEs score influenced my PTSD.

Wendie:
Thanks for commenting. Maybe you have symptoms AND you are resilient. I'm sorry things are difficult right now. You have been through a lot and deserve lots of support. I hope you have it. Warmly, CIssy

Thank you so much for writing about this.  It feels like the authors of the Danish study (hopefully unintentionally) mis-used the term "resilient" in such a way that it sounds like a value judgment and blames those who had trauma exposure prior to their military service. That's really problematic. The issue of childhood exposure to trauma as a risk factor for PTSD for combat veterans is an issue that bears more study.  I was part of a team that evaluated a federally funded multi-site jail diversion program for veterans who were trauma survivors, and virtually all of the participants had exposure to traumatic events before the age of 18 as well as during their military service. 

Mem Lang posted:

 

I just laugh or want to cry when I hear this word touted in education. One size fits all. So simple.  I'm trying to be patient as this is I guess, an evolving understanding by all. Still if you've lived in a war in the house you were growing up, couldn't call it a home, it's hard to accept.

 

Thank You so much Mem !  I'll add  another factor often ignored or misapplied:  Timing.  "Resilience" as generally used around ACEs often anoints responses-in-process.  The "hard to accept" term is made harder to accept while a trauma-impacted life is still in-process.  Human responses (and severity of responses) have varying time-clocks which would seem virtually impossible to read and to predict  by observing only the exterior circumstance, while the clock is still ticking...

Last edited by Daun Kauffman

Resilience... Quite a few on this website have voiced their dislike of the word. Yet, as a wordsmith Cissy, you know it has a powerful impact on our perceptions.  So many personal implications can be derived from this one word:  that it's you not what happened to you.  Very trauma uninformed!

I just laugh or want to cry when I hear this word touted in education. One size fits all. So simple.  I'm trying to be patient as this is I guess, an evolving understanding by all. Still if you've lived in a war in the house you were growing up, couldn't call it a home, it's hard to accept.

As for PTSD with soldiers, which is  now seriously being finally acknowledged, the same applies.  Torture for example works, that's why they use it. And it can be used until the soldier or whoever breaks down. It can be done over time, upping the method if necessary.  So at what point can one say they were resilient, where is that point when they breakdown and how do you compare that to another? Every situation is different.  One would need to take a scientific approach to be able to deem one person more resilient than other.  As we're human this is almost impossible. Different backgrounds, genetics, etc, different ACEs and child protective factors, etc etc. Complex.

Now some of us were in a war situation in the house we grew up in, the no.s vastly more numerous than soldiers, yet it's deniable as we don't help the patriotic cause.  But it will come, as long as economically our countries are at least ok.

That is why I have a huge problem with resilient questionnaires, and have sought on this website some feedback as to how we could make them more trauma friendly, rather than traumatising.  Ie you're not doing well enough. The questionnaires I believe fits like a square peg in a round hole.  Yet considering all factors, one may in fact have moved forward substantially. Empowerment is surely the goal.

So Cissy, it'd be great to take a current questionnaire and turn it into something far more palatable. I'd keen if you were interested, in developing something like this!! I think there could be a few people who see the need and are also interested. Maybe!

Very well said, Christine. I, too, have expressed problems with the use of Resilience as a goal for addressing ACE's. I want to share Dr. Felitti's comments on the topic with you [LINK HERE]. In his paper, Origins of Addiction: Evidence from the Adverse Childhood Experience Study (2003) he noted the experience of Viet Nam Veterans who used alcohol and drugs. 

"American soldiers in Vietnam provided an important although overlooked observation. Many enlisted men in Vietnam regularly used heroin. However, only 5% of those considered addicted were still using it 10 months after their return to the US.15, 16 Treatment did not account for this high recovery rate."

Dr. Felitti refers to a study done about returning Viet Nam vets [LINK HERE]. Heroin addiction did not behave as conventional wisdom said it did among these soldiers. And although the ACE Study had not been completed, it was clear that pre-existing conditions impacted a substantial number of the veterans using heroin who remained addicted after their return.

My concerns are similar to yours, which are well stated. To that I add the impact of positive brain chemicals and exercise to the possible options for the positive behaviors that come out of high ACE individuals. When we are complimented, the flush of positive chemicals leads us to crave more of them, and reinforce the behaviors that are positive. It doesn't negate all of the negative behaviors, however. I think we add neutral and negative behaviors when we aren't getting all of the approval we need. 

Good job. Now we need to figure out a way to change it.

agree - PTSD IS resilience - albeit a harsh form of it - I am thankful for all the "symptoms" that took me through some horrifying experiences.  I am forever modifying my defenses - a lifetime project.

 

Thank you for your response to the word resiliency. As a military officer I have been deployed 8 times in support of Operation Enduring Freedom-four tours in Afghanistan. Since my last deployment three years ago,my life has been difficult and I have had both physical and psychological manifestations of toxic stress. I thought I was so resilient and had overcome my ACEs score of 7. I was wrong. Your response shined the light on how my resilience has allowed me to succeed in my military career but my ACEs score influenced my PTSD.

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