Resilience is the latest buzzword, especially in context of Mental Health for Doctors (#MH4Docs). But what does it really mean, and why is there such resentment against the term from some groups?
Definition of Resilience
(English Oxford Dictionary) Noun :
- The capacity to recover quickly from difficulties; toughness.
- The ability of a substance or object to spring back into shape; elasticity.
In relation to Mental Health (American Psychological Association) :
- Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means “bouncing back” from difficult experiences.
Tree Goats of Morocco
There have been numerous studies done looking at the neuroscience of resilience, and I’ve listed a couple in the useful links section below. One of the interesting findings [1,2] in animal studies was that resilience was promoted by control over cessation of the stress.
It’s important to distinguish two different terms here
- Stress resistance – “stress resistance delays the ‘tipping point’ from adaptive to maladaptive responses and increase the duration and/or intensity of stressor exposure needed to cross over.”
- Stress resilience – “stress resilience, in contrast, facilitates recovery after stressor exposure that has crossed the ‘tipping point.’ “
Reason I mention this is that, there is a risk that a lot of the strategies being implemented, in response to the increased awareness and outcry about Mental Health in Doctors, will end up aiming for Stress Resistance rather than Resilience. Also part of the angst and resistance to the idea of “Resilience” is that there’s a perception that the two above terms are interchangeable.
Resilience why is it important?
Professor David Peters – the Director of the Westminster Centre for Resilience, states that [3]: “Long before a loss of resilience leads to illness, the stress response makes us less sharp-witted and more unfriendly. Even quite mild acute stress triggers a striking dip in cognitive abilities, a loss of judgment, and a significant loss of interpersonal skills. This is no recipe for a successful consultation, still less for a safe and satisfying career in medicine.”
So resilience is seen as a way to stave off burnout and a way to improve the way we deal with stress responses. Resilient people are said to have the ‘emotional flexibility’ to balance negative emotions with positive ones [4].
So how do we become more resilient?
There are a number of programs out there, and you can look up a few online.
- This one by the AMA (American) – is a useful overview with a quick module: https://www.stepsforward.org/modules/improving-physician-resilience
- The RACGP has a good guidelines on self-care.
- AMA Qld have also developed a resilience program to help junior doctors.
- Avant have a nice article on resilience with a great diagram to break down the aspects of resilience:
Figure from AVANT – Resilience: Strategies for weathering the storm
Most of these things we’ve already discussed in some of our previous posts, and links in well with the aspects of Wellness in the “Wellness Care Plan for doctors” post we had before. Some of the other things are mentioned in the “Burnout: Are you Toast” post we had. These all contain generally sensible strategies, which we all know – we recommend these to our patients on a daily basis. We just need to start applying them to ourselves, and coming to terms with the fact that we’re human with all the frailties that entails. This doesn’t mean that we have to be accepting of the situation, if we see a patient undergoing continual stress from a situation we don’t just tell them to improve themselves, we also tell them to change the situation/environment.
Why is there backlash against the term Resilience?
There’s been some discussion about the usefulness of this term, and there has been some backlash in social media.
Why?
Part of the reason which Dr.Maxine Szramka articulated well in her blog (‘Resilient’ doctors, or, Doctors on Fire?!) is that Resilience is about “surviving” stress, burnout and the pressures of work and mental health issues related to them. It’s about maintaining the status quo, and not actually changing the system that has led to the issues of burnout or stress/mental health. The term implies a failure of the individual in not being resilient enough, that the failings and reasons for the mental health issues are due to the individual themselves, not due to the system and the stressors that are put on them. It’s also tied in with the old hierarchical system of medical education and training with connotations of “Toughen up” , “…in my day…”, and all the other patronising terms that many of us would have faced at some point in our training.
The term and the way it’s being used, has suggestions of slogans that middle management bureaucrat delight in. The programs and policies coming out with the phrase “Resilience Programs” seem to lack substance, and appear to be patches on a much deeper problem. That is one of the main worries that the term resilience has become a throwaway word to show that something is being done, without actually accepting there is a significant problem in the system or even doing anything sustainable to address it.
Conclusions
One of the issues regarding the use of the term resilience is the definition and perception – partly with similarities with stress “resistance” rather than stress “resilience'”. The language and the fact that it promotes a lifeboat mentality of “survival” of the situation rather than attempting to change the actual conditions, are areas of concern. Yes it is a useful tool to have in the arsenal against burnout and improving mental health in doctors, but it’s not a solution to someone falling off a cliff – maybe just a bungee rope to bounce them back up for a short time. However it is a lot better than “stress resistance” solutions , which just delays the person falling off that cliff, to push them higher up before they fall. We shouldn’t dismiss the lessons and skills “Resilience” offers us in our lives as medics, but there needs to be caution in how it is used by administration and health systems. It is a low hanging fruit, allowing the pretence of change, offering support and solutions for those who may be going through burnout. If not used correctly or contextually may just lead to worse outcomes, and very importantly deflect from actually dealing with the actual problems in the system.
Whatever your take on Resilience in the realm of burnout in medicine, it can offer some useful tools and skills, but I think we need to move away from seeing it as the only solution for mental health problems faced by doctors.
Useful Links and References:
- The Australian Doctors Health Network provides specific support for doctors and helps find a GP for them – www.adhn.org.au
- Anyone across Australia experiencing a personal crisis or thinking about suicide can contact Lifeline, confidentially, on 13 11 14.
- The RACGP also offers a support program for its members – RACGP Support Program .
[1] Russo, Scott J. et al. “Neurobiology of Resilience.” Nature neuroscience 15.11 (2012): 1475–1484. PMC. Web. 7 July 2017.
[2] FLESHNER, MONIKA et al. “The Neurobiology of the Stress-Resistant Brain.” Stress (Amsterdam, Netherlands) 14.5 (2011): 498–502. PMC. Web. 7 July 2017.
[3] The Neurobiology of Resilience by Professor David Peters – Director, Westminster Centre for Resilience
[4] Tugade, Michele M., and Barbara L. Fredrickson. “Resilient Individuals Use Positive Emotions to Bounce Back From Negative Emotional Experiences.” Journal of personality and social psychology 86.2 (2004): 320–333. PMC. Web. 7 July 2017.
First Do No Harm: Being a Resilient Doctor in the 21st Century, by by Leanne Rowe and Michael Kidd
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Tags: #mh4docs, burnout, depression, doctors, mental health, resilience, serenity, Stress