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Resilience Reconsidered

There's been a surge of interest lately in the concept of resilience, from both academic and pop psychology. Increasingly we're talking in pain management circles as well about trying to foster and cultivate resilience to chronic pain. I ran a PubMed (National Library of Medicine) search using the terms "pain" + "resilience" as I wrote this post; 558 articles were identified, with over 500 of them from this decade (389 within the past 5 years.)

There's a time and place to talk about resilience; to borrow an analogy from Loma Linda's Dr. Richard Rice, such a discussion is better regarded as physical therapy rather than emergency surgery. In other words, to the person in the midst of acute and overwhelming suffering, discoursing about resilience probably isn't the wisest (let alone most compassionate) tack. But when some time has passed after that surgery, so to speak, rehabilitation isn't just a good idea, it's necessary if we are to regain function - and get along with life in a difficult world.

Resilience means different things to different people, but generally we think of the ability to bounce back, keep our chin up, take it in stride, and a host of other metaphors describing some combination of flexibility, grit and undeterred-ness (that's not a real word.) It should be noted up front (as most in-depth scholarly papers on the subject do) that someone may possess significant resilience in one arena of life (for example being able to withstand/weather emotionally or otherwise abusive relationships) and yet not be able to cope with physical discomfort, or vice-versa. Resilience is also a dynamic phenomenon - all sorts of different factors (take sleep deprivation for example) can bring us to a breaking point that otherwise wouldn't have occurred.

In the arena of chronic pain research, certain characteristics have been shown consistently to be associated with resilience, including:

  • acceptance

  • optimism

  • healthy, caring and supportive relationships

  • a sense of purpose in life

...and the American Psychological Association (APA) in their "Road to Resilience" offers the following advice on developing resilience:

  • accept that change is an inevitability

  • avoid the perspective that crises are insurmountable / "keep things in perspective"

  • take care of yourself

  • nurture self-confidence, and maintain optimism/hope

  • choose action, set realistic goals and pursue them

  • pursue and tend relationships

'Acceptance' of pain is barely enough to tolerate it if severe and chronic enough; embracing it as a necessary catalyst for transformative growth may be the only way to survive it if bad enough.

There's certainly some wisdom in those suggestions and we'll look at a few components in greater detail below, but first I'd like to focus on what I really believe is the most critical and frequently overlooked ingredient in resilience: going through the process. Pardon the overused analogy, but I'm afraid that the typical modern 'microwave generation' quest for resilience is doomed to failure. Resilience of mindset and character requires quite a bit of prep and bake time. Developing patience requires patience...

Again, the main thing to consider - maybe too obvious at first glance - is that developing resilience requires stress. It's fairly well accepted that the trees in the famous Biosphere experiments in the 1990s (unlike the beautiful birch in the photo above from Chugiak, Alaska) failed to thrive or died due to lack of sufficient wind in the dome. Without wind, trees aren't challenged to send roots deep enough, and they don't develop the mettle to survive inevitable stresses.

Biosphere 2. Photo by Hbarrison [CC BY-SA 4.0 (]

Speaking of mettle... The process of tempering steel to make it resilient as well as hard (think of a huge industrial spring) requires a tremendous degree of heat (and expertise) applied to the steel after it's already been exposed to dramatic and molecularly distorting heat and cooling to render it as hard as possible. That hardening process, however, in the absence of tempering results in a metal that is brittle and unable to withstand stresses greater than its own capacity to support, so to speak. Bend or break, as the saying goes, and that flexibility comes at a cost - in this case, more time in the furnace.

With all due respect to the APA, and the modern American 'mindfulness' clique, positive thinking, homework assignments and support groups aren't enough to develop resilience. 'Acceptance' of pain is barely enough to tolerate it if severe and chronic enough; embracing it as a necessary catalyst for transformative growth may be the only way to survive it if bad enough. Many of you may justifiably hate the expression "no pain, no gain!" usually voiced by youth who haven't experienced chronic pain and all that entails. But there is truth in the saying, and it bears repeating that without chronic pain, one cannot develop pain resilience.

St. Paul wasn't speaking directly or exclusively about physical symptoms, but the man (who knew an awful lot about pain and suffering) wrote to encourage Christians in Rome to "glory in tribulation" and not just in the good times/happy feelings,

knowing that suffering produces endurance, and endurance produces character,

and character produces hope

The tree isn't intelligent enough (to our knowledge anyhow) to appreciate the wind, nor the steel the furnace. But we have the opportunity to not only accept, but value transformation, and the process required. And many have found that that positive re-framing (reinforced by a sense of purpose, and by relationships as discussed below) was the key to overcoming chronic pain or transcending it.


Cognitive-behavioral discipline is a good thing. Learning to recognize and replace distorted thoughts and emotions is never wasted effort. But the studies on resilience show that more important even the the psychological dimension are the social and spiritual dimensions a person brings with them into the crisis.

The Japanese are renowned for their resilience; after devastation in World War II, the ascension of the country's economy to second place globally after the United States took a mere two decades. In March 2011, the terrible trifecta of the 9.0 Tohoku earthquake, the tsunami that followed (with waves of 130 ft. traveling over 400 mph for over 5 miles inland) and the Fukushima nuclear reactor accidents combined to claim almost 16,000 lives and cause the costliest natural disaster in history. Yet the world was arguably more awestruck to witness the heroic power of solidarity demonstrated by a people who value their community, nation, dignity and culture above their own lives. In Japan, as in most of Asia, acceptance is certainly fundamental to a person's worldview; societal good and the individual's contribution to it however are paramount and this sense of both purpose and relationship were manifest throughout the latest dark chapter in that proud island's troubles.

Purpose and relationships (including the most important relationship a person can have - with their Maker) substantiate or 'flesh out' the eternal currency of Faith, Hope and Love that St. Paul also wrote about in 1 Corinthians 13. All else in life - even the pain that may seem endless - is transient, but "these three remain." Resilience - the ability to outlast life's inevitable storms - can't develop without those storms, as we touched on above. But we've also got to survive the storm, and the anchor (sometimes lifeboat) of relationship and the lighthouse of purpose are necessary ingredients too.

Heath McAnally, MD, MSPH

8 Jun 2019


Content on is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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