Is ‘Resilience’ a Positive Descriptive or an Insidious Bias?

Resilience. That word has been living rent free in my head for the past three weeks. And rent free is a bit of understatement. It all began at the end of a very productive clinic, when the trainee and I sat down to discuss our reflections on the interactions with patients that we’d had in the clinic that day. The trainee mentioned one lady who had “extraordinary resilience” because of the refractory nature of her inflammatory myositis and the challenging socioeconomic circumstances that she had to confront. I understood that this was a laudatory statement full of admiration. It was fundamentally an empathic statement that I believe came from the heart. Yet something else was there—something that inadvertently snuck in between the words—that gave me room to pause.

Since that time, I’ve been seeing the word resilience everywhere—at least five times a day, at work and at home. Every single time, it provokes some unease. What does resilience even mean in this day and age? What are the assumptions that we make when we use the word resilient? What’s the future of resilience? Let’s rheuminate.

Defining Resilience

In its most literal form—as in the definition in Merriam-Webster’s dictionary—resilience is “the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress.”¹ The word seems to be rather ancient, related to the Latin word salire, which means to jump.² Our modern day usage, with respect to people (“an ability to recover from or adjust easily to misfortune or change”), seems to have been first documented in 1830.

Perhaps a more modern take is in the American Psychological Association’s Dictionary of Psychology (published in 2006): “Resilience is the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands.”³ The entry elaborates: Resilience can be cultivated and practiced. This element of resilience deserves particular emphasis.

These definitions raise more questions, at least in my mind. Clearly, at its core, resilience is about the ability to withstand and recover from adversity. It’s the physiological capacity to cope with adversity and setbacks. But does this mean that resilient people don’t change but rather bounce back? Does resilience imply that we need to falter to succeed? What makes certain people more resilient than others?

Romance of Resilience

Perhaps more important than the literal definitions of resilience are its connotations. In our society, we often romanticize resilience, painting it as a superhero quality that enables individuals to overcome any obstacle. We hold up stories of triumph and resilience as examples to inspire and motivate. And while these stories are undoubtedly powerful and uplifting, we must be cautious not to oversimplify the complex nature of resilience. It’s not a one-size-fits-all solution or a magical elixir that guarantees success in the face of adversity.

Contrary to how we conceptualize it, I don’t see resilience as a state of constant, unwavering strength. Resilience can only be seen in moments of weakness and vulnerability. A person living a seemingly ideal life cannot be blamed for not being resilient because that individual never had the opportunity to demonstrate resilience. And more to the point, who are we to judge someone’s resilience? That seemingly ideal life may very well be an illusion.

Therefore, when I hear someone use the word resilience, I recognize it not as a characterization of an individual but rather as a commentary about a larger system. It’s a yearning to recover a sense of agency in a world that is often uncaring to personal circumstances.

It is easy to get drawn into that romantic feeling. Even writing this column makes me feel a little nihilistic, although that is not my purpose. Humans are hard wired to believe in a just world.⁴ The idea of resilience is appealing because it gives us confidence that our insecurities are not fatal flaws and that a countervailing force can mitigate the worst of potential outcomes. It also gives us a sense that we can bounce back to better times, rather than get used to new realities.

In the clinic case, my sense is that the trainee was coming to grips with the relentless nature of this difficult-to-treat rheumatic condition. The fact that the patient was so personable and sympathetic did not square with the reality that she was in a state of suffering. Resilience came to remedy this inequity; that is the patient may be in pain but she can endure that pain because she is resilient.

Resilience as Judgment

As I continue to reflect upon the concept of resilience, I can’t help but see that its definition seems to hinge upon its absence. After all, resilience is deeply personal and contextual. What may be a minor setback for one person can feel insurmountable to another. Our experiences, backgrounds and resources shape our views. For better or worse, we often project our own preconceptions upon others, coming up with conclusions on such concepts as resilience.

When we decide that someone is resilient (or not), we are looking at an individual’s strengths and vulnerabilities, and making a decision about whether that person is sufficiently utilizing their strengths. There is something even more insidious about labeling resilience than there is in making other judgments based on single data points because it rests on multiple subjective assessments that are interlinked. A holistic bias exists that cannot be avoided, no matter how much we try.

Thinking of it in another way, we reverse engineer what we consider to be resilience. When someone or something persists and we like it, it is resilient, whereas if someone or something persists and we dislike it, it’s stubborn or defective. In point of fact, both types of binary judgment rest entirely on our own preconceptions. They are greater commentaries on ourselves than others.

When we say a patient is resilient, what we’re signaling is that this patient is deserving of our respect. We are saying that they deserve a boost from us because they seemed to do everything we would consider to be right. If I said that this patient with myositis smoked tobacco and was not interested in quitting, would we be as comfortable saying they are resilient?

Resilience Is Variable

The other discomfiting element of the word resilience is that it seems to more commonly describe individuals than communities. Our modern American society values rugged individualism (e.g., pulling yourself up by the bootstraps, being a self-made person, setting out your own), but individuals are deeply interconnected. The concept of individual resilience seems to de-emphasize relationships.

In the case of our patient, she may very well be resilient, in the classic sense of the word. But she likely also depends upon many others to maintain that resiliency. By focusing on her resilience and not acknowledging anyone else’s, we’ve simplified a complex scenario.

Even if you concede that resilience is a trait at the individual level, resilience isn’t a static value that pops out of a vacuum. Resilience—or, at the very least, the collection of virtues we associate with it—is very much the result of habits and mentalities that we inculcate through the course of our own lives. Twin studies suggest there may even be an inherited component.⁵ Similarly, just because someone is resilient today doesn’t mean they will remain resilient in the future. So saying that an individual is resilient can be misleading.

Moreover, for many people in our world, mere existence is a testament to their own resilience. Our world is defined by a set of injustices and inequities that trace back long into our histories. The fact that so many of us from marginalized and minoritized communities even exist is a sign of resilience that has been conveyed from generations untold. For them, resilience isn’t a virtue so much as a truism of life. By labeling somebody resilient, we deny that historical record. At worst, we implicitly indict someone’s ancestors for not being resilient enough in the way that we expect them to comport.

This reflection may help explain my discomfort. Coming back to the clinic, when the trainee mentioned resilience with respect to the “challenging socioeconomic circumstances,” I heard a faint, unintentional justification for healthcare disparities. After all, there may be challenging situations, but she’s coping well, presumably due to her resilience. Resilience lulls us into a belief that if only other people had a sunshiny, optimistic attitude, they would be in better situations. The truth is far murkier.

A New Resilience

As you can guess, I think the bounce-back type of resilience is an antiquated concept. It’s Darwinian in nature, and although well meaning, it reinforces certain assumptions and paradigms that we should reassess.⁶ So it may surprise you that I still believe a role exists for the word resilience. This new resilience is more akin to the concept of self-forgiveness, is less binary than a spectrum and aligns better with the values of community.

In the 21st century, resilience should not be seen as a solitary pursuit, but as a collective endeavor. It’s about fostering communities of support, empathy and solidarity. It’s about recognizing that our sense of individuality is interconnected with the resilience of the community around us. Think of the original definition of resilience—a material that can withstand compressive strength. When that material is placed together to reinforce its own strengths, it is better able to withstand the stress. It becomes resilient, even though by itself it may not have been. When we say resilience, we should incorporate that element of mutuality.

Further, as we reimagine resilience, we must acknowledge the importance of selfcare and self-compassion. Resilience should not mean pushing ourselves to the brink of exhaustion or denying our own needs. I have encountered resilience frequently in burnout literature. I can’t help but see the word as a convenient out for societal pressures that contribute to burnout. We should invert that understanding: Organizations are resilient because of the goodness of their people, rather than people are resilient because of the goodness of organizations.

For those reasons, I no longer comment on the resilience of other people. When I hear it from trainees, I gently ask them to reconsider their words and to challenge their assumptions. It’s a small but important step that signals a break from the past and a commitment toward equity and inclusion.

The Future of Resilience

In this rapidly changing world, the concept of resilience must evolve and adapt. This new resilience is less about bouncing back to some imaginary past level of strength, but instead about adapting to new realities. It’s about embracing uncertainty and cultivating a growth mindset. Resilience is not a snap assessment in a point in time, but an ongoing journey of self-discovery, community and growth.

Let’s reimagine resilience as a collective force, a web of interconnectedness that supports and uplifts us all. Let’s cultivate resilience—however we may define it in our minds—within ourselves and in our communities, recognizing the power of vulnerability, compassion and self-care. Let’s embrace the complexity of resilience and celebrate the strength that lies in our ability to rise and thrive, even in the face of great adversity.

In the end, resilience is a shared experience: When we observe it, it reminds us of our capacity to overcome, to adapt and to find hope and justice in dark times. Resilience is not a distant commentary on someone else’s experience but a reflection of our own beliefs and assumptions about what should be preserved and strengthened. Resilience as a term is surprisingly resilient. It reflects our society’s values and holds a mirror to our own self-conception of our place in society. Perhaps that is why resilience continues to live in my mind, totally rent free.

Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS, is the associate program director of the rheumatology fellowship training program at the University of Iowa, Iowa City, and the physician editor of The Rheumatologist. Follow him on Twitter @BharatKumarMD.

References

1. Resilience. Merriam-Webster. 2023 May 28. https://www.merriam-webster.com/dictionary/resilience.
2. Resilient. Etymonline.com: Online Etymology Dictionary. 2021 Jul 20. https://www.etymonline.com/word/resilient.
3. Resilience. APA Dictionary of Psychology. American Psychological Association. https://www.apa.org/topics/resilience.
4. Nartova-Bochaver S, Donat M, Rüprich C. Subjective well-being from a just-world perspective: A multi-dimensional approach in a student sample. Front Psychol. 2019 Jul 30;10:1739.
5. Amstadter AB, Myers JM, Kendler KS. Psychiatric resilience: Longitudinal twin study. Br J Psychiatry. 2014 Oct;205(4):275–280.
6. Olsson L, Jerneck A, Thoren H, et al. Why resilience is unappealing to social science: Theoretical and empirical investigations of the scientific use of resilience. Sci Adv. 2015 May 22;1(4):e1400217.