The Blog Has Moved

Whoa. Chris and Vic (that lovable duo also known as CAK) have hit Dr. Rob with a tough one.

Dr. Rob, do you ever write about serious items?

If so, how about your take on “resilience”? Is resilience a cure for trauma and hardship? Is resilience a constellation of coping mechanisms? Or ???

What if your child has serious disabilities and cannot even understand the concept of resilience? Does that make him less resilient? Does cognitive or behavioral disability disqualify him from developing resilience?

Is there a way to train for resilience?

First let me give the “dictionary definition.”

resilience (n.) The ability to recover quickly from illness, change, or misfortune; buoyancy.

resilience (n.) The property of a material that enables it to resume its original shape or position after being bent, stretched, or compressed; elasticity.

Second, let me give you a guy with a really deep voice saying the word:

[Audio:Resilience.mp3|autostart=no]

Dang. I wish I had a voice like that. That guy would sound good reading the phone book.

OK, so I assume that the word resilience in this setting is regarding those people who would continue to stand under incredible circumstance. Resilience is the ability of people to take the blows that life dishes out and to continue to be yourself.

First let me say that personally I have had to display very little resilience. My life has been so much easier than that of most people. I have been handed much of it on a silver platter (not literally, however), with a great family growing up, a good set of chromosomes (no taco/ketchup tendencies), and very little tragedy. I would dare say that many of my readers have had to display far more resilience than I have.

Yet I do know something about resilience, as I am an observer of people, and have seen quite a few people who have gone through incredible hardship. I have a whole lot of admiration for those people and feel that they will be quite a bit above me when the final life awards are handed out.

Let me give a few examples:

Example 1: Tina

Tina is a patient of mine who is in her mid-thirties. When she was in her early twenties, she was engaged to be married. When she was out at the mall to pick up her wedding dress, a robber surprised her from the back seat of her car, shooting her in the neck. After many surgeries and years of rehab, she ended up with no use of her legs, and only partial use of her arms. She lives with her family and comes in to me for problems related to the effects of the injury to her sympathetic nervous system.

You would think that she would be bitter and angry about things, but she is always smiling. One time when she was in the hospital for a colon obstruction, the nurse told me that she “fell in love” with Tina. Her visits are always enjoyable to me, as we talk about her dogs and her nephews and nieces whom she helps to care for. While she does complain about things at times, she in no way dwells on her disability. She seems to want to make the lives of the people around her better for her being there. She succeeds greatly at that.

Example 2: Regina

Regina is in her 40’s and has Down’s Syndrome. She lives with her mother and step-father who has Alzheimer’s. Her mother said to me once, when I told her that another patient had just had a child born with Down’s, “You tell her that you have just been sent a little angel to be by your side for the rest of your life.” Regina loves coming to the doctor and gives me a hug every time she comes. The main thing she asks for when she comes to the office is a “shot.” Since she has thyroid problems, I can sometimes give in to her request by drawing labs.

Example 3: My Sister

I have 3 big sisters (and lived to tell about it). The youngest of the three is six years my senior. She is a registered dietician and is married to a wonderful guy whose only fault is the fact that he roots for the Yankees. She is a breast cancer survivor, but that is the least of her battles. Of the three children she has had, two of them were born with Spinal Muscular Atrophy, also known as Werdnig-Hoffman disorder. When her second child was born, my oldest son was less than a year old - he is now fifteen. SCA is a disease that causes a child to not be able to use most of their muscles. It causes complete paralysis (in its worst form) and will typically lead to respiratory failure and death.

The disease is an autosomal recessive disorder, so there is a 1 in 4 chance of a couple who carries both genes to pass it on to their children. When their older son was still fairly young, but growing in his disability, my sister became pregnant with another child. They chose not to do testing at that time (I am actually not sure what was available), but watched closely after their youngest son was born. Sadly, it became quickly apparent that he too had the disease. His disease took an even more aggressive course than his older brother and he died at 6-months of age.

The surviving son has stayed remarkably healthy. He eventually required mechanical ventilation, and requires full-time supervision (split between visiting nurses and his parents). He has no use of his muscles, communicating through movements of his eyes on a board. He has been able to go to school and seems to have a normal-functioning brain, but is much hampered by his inability to communicate.

My sister has been remarkable through all of this. She does not pretend that life is not hard, but she does face the hardships with a degree of stoicism. She has remarked that people somehow think that if you have a disabled child, then your house must be a place of gloom. The fact is, they have good and bad days; they laugh and joke around. This is normal for them.

Resilience vs. Adaptability

All three of these women I have such respect for demonstrate resilience to me. Tina and my sister show it in their ability to keep their head up even when life seems (and is) unfair. They have somehow found the ability to look beyond comparing their life to that of others and simply play with the hand that has been dealt them.

Regina shows it just by enjoying life on her own level. She seems no less of a person with her disability. She has very bad moods at times, but overall is the same person that I met ten years ago.

The thing that seems to be lacking in all three of these remarkable people is anxiety. I am sure that they struggle inwardly like the rest of us, but outwardly they show very little worry about what the future will bring. Perhaps they know more than we do that life can hand out horrible things and that looking ahead may not be a good idea. Perhaps they have seen that even if the bad things do happen, it does not take away the ability to still find some enjoyment in life.

While I am not certain about Tina, my sister finds her strength in her belief that behind the worst of things, there still is the loving hand of God. The hardships she has endured have not hurt her faith at all; in fact, she has far stronger faith than I will ever have. She sees life as being rooted on something that is extremely reliable and good, and so sees only the bad as being temporary.

I think that whatever the religious belief, the resilient people I know all view life in this way. They don’t look around the corner hoping that bad won’t happen; they seem to be sure that despite bad things, good will never be far off.

Yet I wonder if resilience is the best term. What these people have seemed to have done was more to adapt than to resist change. Resilience seems to imply that you don’t change, whatever the circumstances dictate. Those people I hold in such high esteem seem more able to adjust to their surroundings and accept the good and bad things in life. Their ability to stand comes from their ability to adjust to whatever pressures are put upon them. When life does get hard, they are willing to seek help and not just stand stubbornly.

The Source

I remember once when I was visiting Kenya. My father had retired and was teaching at a University there for a year. We were invited to eat dinner at the house of a person who lived in one of the slums of Nairobi. The home was a single room with a dirt floor. They were so thrilled that we were there that they killed one of their chickens and served it to us for dinner. While I found it a little hard to eat in those surroundings, I remember thinking about how happy these people were. There seemed to be so much less anxiety in their lives than I had in mine. I have eaten at many banquets in my life, but never have I felt so honored by my eating companions than during that meal.

I think it is a western phenomenon to be caught up in worry. We are insulated from pain, and so worry that it may come. We are like a child who is due to get an immunization. The shot will not really hurt a whole lot, and will help keep them healthy in the long run, but the child can think of nothing but the anticipated pain. It seems to me that the pain we may fear the most may actually free us from the anxiety we are so trapped by.

It seems to me that resilient people have discovered that secret. They understand that pain is simply a normal part of life and so it does not hold them captive in fear.

While I have had very little personal pain, I have been fortunate to have observed some very amazing people. If I do have to go through pain like theirs, I hope that I can show the same kind of strength.

Can we teach resilience or adaptability to our children? Probably the best way to do so is to either display the character ourselves when we face hardship, or put our children in a position where they can see others displaying resilience. Living in our isolated cocoon against pain in the West, we do nothing to build resilient children. To show our children that pain is real and that the goal is not to be “comfortably numb” pushes them beyond the pettiness in which many people live. Seeing those people around me who bear so much and yet show that they are doing more than just tolerating pain makes me much more able to get up off the couch and do harder things.

Perhaps getting off the couch is the hardest thing to do.

Thanks for the question. Expect the next of these to resume the usual tact of mocking intelligent thought rather than engaging it. I can only use my mind so much, you know.

Don’t forget to submit questions to dr.rob.questions@gmail.com.

This entry was posted on Sunday, August 26th, 2007 at 5:42 pm and is filed under Ask Dr Rob. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.