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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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Comments (32)

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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.

Peter Chiavetta posted:

Resilient • (of a person or animal) able to withstand or recover quickly from difficult conditions: the fish are resilient to most infections.

Resilient doesn't come with fireworks and brilliant lights. It's an ability. We all understand the prerequisite. Resilient is not the same as flourish. 

flourish verbferns flourish in the shadegrowthriveprosper,do wellburgeonincreasemultiply,proliferatespring upshoot upbloom,blossombear fruitburst forthrun riot.

Speaking for myself, I also felt a level of discomfort with "resilient". In my own mind I think resilient had a sparkle of flourish in it. Now that you brought my attention to it and I really looked at the true meaning, I'm cool with resilient.

Peter:
Thanks for the work you do and for being all "ACE in your face" about it as your daughter says!

I'm finding that resilient and resiliency are used a bit differently and how and when it's used matters a whole lot as to how I feel. Thanks for adding definitions and your own evolution with this word!

Cissy

Resilient • (of a person or animal) able to withstand or recover quickly from difficult conditions: the fish are resilient to most infections.

Resilient doesn't come with fireworks and brilliant lights. It's an ability. We all understand the prerequisite. Resilient is not the same as flourish. 

flourish verbferns flourish in the shadegrowthriveprosper,do wellburgeonincreasemultiply,proliferatespring upshoot upbloom,blossombear fruitburst forthrun riot.

Speaking for myself, I also felt a level of discomfort with "resilient". In my own mind I think resilient had a sparkle of flourish in it. Now that you brought my attention to it and I really looked at the true meaning, I'm cool with resilient.

Cissy:     [during college] I only had access to a printed paper copy of the essay: "Professionalized Service and Disabling Help". Regretfully, I only recall the title, and not the author.      I don't recall anyone even discussing "Co-Dependence", at that time, either. CoDependents Anonymous had a website, last time I checked. If I have an opportunity to look for further essays, etc. I'll try. Two books, both by one of my professors, may be germane to this discussion: I. Ira Goldenberg wrote: "Build Me A Mountain:...", and "Oppression and Social Intervention: ...". I believe it was for one of his classes that we also had to read the essay, noted above.

Another text I recall reading, noted in the introduction, that a survey had been done of All the Bachelor's degree'd members of the California Nurses Association, and 85% admitted to growing up in 'Alcoholic households'--it may have been: "Witches, Midwives, and Nurses: A history of Women Healers" by Barbara Ehrenreich. 

The Impact of our 'Individualistic Culture' and its' reliance on only 'Dispositional' factors, as the 'Medical Model' does, may serve to reinforce the 'professional judgment' of those 'professional 'World Views', whereas the 'Public Health model' considers 'Situational' and  'Systemic' factors-such as the ACE study did. This too, may impact how we 'view' the concept of "Resilience".

Last edited by Robert Olcott
Hi Robert: If you want to share any of those essays I'm sure lots of us would be interested. I've not heard of professional co-dependency before or meetings. I'd love to learn more.
Cissy
Nancy Isserman posted:

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. 

Nancy:

This is fascinating research. Thanks for sharing it. Do you know if there's any similar research for those with high ACEs where the cause of trauma was the family experience? I heard Rachel Yehuda talk a bit about Holocaust survivors and the way that children of Holocaust survivors, who did not have the same trauma, shared PTSD symptoms. One of the things she talked about was being open about symptoms, with our children, as people parenting with PTSD. But I've not been able to find much on this topic as related specifically to parents who are parenting with traumatic stress from our parents or family environments and the ways in which we can mitigate impact for our own kids. 

I'll read more about the TTP and am very interested in any research you might know about.

Thank you so much!
Cissy

Rachael McDougall posted:

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.

 

"Modifying my defenses - a lifetime project" 

Yes! 

Thank you for that Rachael. It's so well said! I know exactly what you mean. 

Cissy

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. 

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

Christine Cissy White posted:
Raymond Lambert posted:

I am delighted to see such a good response to this post. I don't like the word Resilience either, and I wish the brave movie makers had chosen another title for their film (only the title, the film is wonderful).  In the wider world, resilience is presented as an innate quality, a state of being, a natural part of our human condition, something to tap into, to draw from, as if we had an ready-to-use font of it in our bodies. Resilience seen as something present in a passive way, and not the result of an active process.  I hear and see it mostly - and this is why it annoys me so much - when it is referred to in the context of hurt/abuse/neglect with children : every time we say < Children Are Resilient > (and they'll get over it) we draw the attention AWAY from the causes of the trauma; we give ourselves and others, a reason to NOT have to talk about these causes. And the culprits/violence/society get away with their crimes and actions. In my book, resilience is the *end result of trauma properly processed* (meaning with the right help, conditions, support and techniques if any), and in the most natural way possible. PS: Nature has equipped us with such a way, that's why we are still on the planet, and evolving, instead of having been wiped out.  Christine, let me know if you want to  hear more about 'the little ducks'.  And  Wendie, look up TRE - trauma releasing exercises. 

Raymond:
I can't wait to see the Resilience movie!

Your wrote:

"every time we say < Children Are Resilient > (and they'll get over it) we draw the attention AWAY from the causes of the trauma; we give ourselves and others, a reason to NOT have to talk about these causes. And the culprits/violence/society get away with their crimes and actions."

I think this is a key part of it. When I talk, I even say, "Let's not rush to resilience" before we understand what people are living with and in and recovering from because it's just more smiley, positive and hopeful to talk resilience. But not everyone makes it. Some don't even survive and it's not that they lacked resilience but that they were overburdened. I think many use resilience to find ways to ease burdens, to lessen impact of burdens, etc. 

There's lots of people talking about resilience and not enough about causes and then there's a lot of people talking stats about the impact of ACEs but without solutions or options that are viable. I think talk of resilience is a way to bridge these two sides of things, system wide, but it's often discussed in terms of individuals and with subtle or direct judgments at the same time. 

What's the title of your book in case others, like me, are interested? 

And thanks for mentioning TRE to Wendie. I've looked into it as well!

Cissy

Hello Cissy.  

No book written (yet) but who knows, I sure have a lot to say  Here is a link about Resilience, with self explanatory image + good and clear notes.  What I love about TRE is the 100% natural process involved, as we share it with all mammals on earth, and the strictly 'physical' aspect of the release.  No doubt people can make the same argument for all-things energy-based-therapies, but because this spontaneous shaking/trembling/tremoring is so basic, innate and primitive, it appeals to me that I don't have to subscribe to any other ethereal higher order or mystery. To sum up, for me : RESILIENCE is the product/bi-product/result of our body releasing the cocktail of stress hormones and chemicals, in a safe and supported way/environment. In one word : E-VO-LU-TION. The gazelle has no therapist in the wild, maybe just the herd if lucky, but WE can provide the safety. You can read Peter Levine's experience (for free) in the first Amazon pages of his book *In An Unspoken Voice*.  Please note that the experiment is over forty years old. And entirely compatible with Somatic Experiencing (SE). Now you can look it up and be on your shaking little way in minutes (+ happy to say I know both Steve and Riccardo)  https://cranialintelligence.co...s-makes-us-stronger/

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