Heroes Not Zombies

One of the characteristics of health is resilience. But what is resilience?

One definition is –

Resilience is the capacity of a system to absorb disturbance and reorganise while undergoing change so as to still retain essentially the same function, structure, identity, and feedbacks.

I like this definition. It captures the essential elements of reorganisation and change whilst retaining integrity and coherence. In other words, when something disturbing happens (and in health terms that can be anything which is a biological stressor – infectious organisms, chemicals, drugs, injuries or operations, or psycho-social stresses ie significant life events) then the system, or the organism, makes an adaptive response. The response has two aspects – defence, which tries to maintain the internal status quo, and reorganisation, which produces change within. Both are necessary, and whilst they can seem like opposites, both functions are required.

When someone is resilient they are less likely to be infected when a bug is doing the rounds, less likely to be overwhelmed or blown off track by major life events, AND they are more likely to recover and repair when damaged, but, more than that, are more likely to change, develop and grow.

As Prigogine demonstrated with his concept of “dissipative structures”, living forms develop and grow by falling apart. Reorganisation involves elements of breaking down, or dis-organising what is already there, and of putting things back together but in a new way.

How do we maximise resilience?

I read a paper recently which considered the phenomenon of resilience in relation to “fragile states” and the author highlighted two ways to maximise resilience.

Firstly, to develop “resilience-sensitive” policies (or actions), and, secondly, to create the conditions which support resilience. I think both of these ideas are useful in thinking about resilience in health care.

Our treatments should be “resilience-sensitive” ie if a drug, or an operation, or whatever other treatment is used impairs resilience it is less likely to be effective than one which at worst is neutral, but at best, is stimulative or supportive of resilience. How often do we think of this aspect in health care?

Secondly, how do we create the conditions to foster resilience? That’s a question that crosses the boundaries from the personal to the social and political. There are environmental, societal and economic aspects to that question. Is a polluted environment going to be conducive of resilience? What about an unsafe community? And what about the increasing inequality in income distribution? At a personal level, what about emotional intelligence? What about food? What about exercise? What about Nature?

What do you think?

What could you do to foster and maximise your resilience?