Key Concepts: 6) Resilience
As I'm writing this today, we (and I mean the entire U.S.A. population) are waiting for Hurricane Irene, which is churning its way up the East Coast, and which is expected to announce itself with torrential bursts of wind and rain just after dark. Only last week, we were surprised by a 5.9 magnitude earthquake, which shook us all up without causing much damage. A few weeks from now, we will be marking the 10th anniversary of the momentous events of 9/11/2001. Beside all this, on a daily basis we see the Dow gyrate hundreds of points per day, rapid-cycling between fear and greed. On the political front, we awaken each morning to global unrest, new uprisings, extreme violence, and to increasingly polarized political leadership that doesn't seem to have a clue.
What a world we live in!
Clearly we humans weren't designed for a world like this. Our stress response systems evolved over hundreds of thousands of years in a world that scarcely resembled our 21st century 24/7 global electronic village. It's no surprise that many people find themselves overwhelmed by the multiple uncertainties of contemporary life. This is especially true for people with depression and anxiety disorders, who can be at risk for particularly bad outcomes when disaster strikes.
Despite all this, I tend to be an optimist. All of these events, all these unpredictable and manmade disasters serve to underline the importance of the 6th and final key principle of the New Neuropsychiatry: resilience.
When disaster strikes, some people crumble, yet others thrive.
Why is this? Over the past few decades, New Neuropsychiatry research has begun to understand the basic factors behind resilience.
What is resilience? It is a scientifically-based concept of effective coping as a means of alleviating chronic stress. When related to psychiatric conditions such as anxiety disorders and depression, we are increasingly able to use our understanding of resilience to improve long-term outcome. But resilience also includes principles that are applicable to everyone--not only those who suffer from psychiatric disorders.
Today, in the words of psychiatrists and researchers Dennis Charney and Charles Nemeroff, "...progress in both psychology and neuroscience make [an] ambitious goal possible: the development of psychological resilience and emotional fitness." This insight grows from research in a dozen different neuroscience disciplines, from clinical psychiatry to genetics to epidemiology to neuroimaging to molecular biology to psychopharmacology and psychotherapy research.
A full discussion of these items is beyond the limits of a single blog posting, but let me pick a few examples:
As a clinician, I have learned a lot about resilience from my patients. Take "Mark M." as I call him in Heal Your Brain. Prior to treatment, he had been overwhelmed for over a decade of depression and severe OCD, with a constant need to check his wife's whereabouts after a devastating car accident. Eventually, he responded to antidepressant medicine and psychotherapy, and attained a state of ongoing remission. Like many people with these disorders, Mark seemed to have had increased activity of the brain's fear systems--which seemed to return toward normal after treatment. A few years into Mark's recovery from depression, the events of 9/11 happened. I feared that Mark would crumble, especially since his wife worked in the vicinity of the World Trade Center, and it took him many hours to locate her. Yet he thrived. He described to me how many of his friends and colleagues developed depression or PTSD afterward, yet how he felt "protected"--perhaps because he had overcome so many previous obstacles. In retrospect I see that Mark had done many of the things listed above to enhance his own resilience, and that he had moved from a state of feeling continually threatened to a state in which he felt continually challenged. Calm had replaced fear as his organizing principle.
Back to the hurricane, earthquake, and these innumerable political disasters: obviously we can only have a limited effect on these threatening world events--natural or man-made.
But it seems to me that there is a greater need than ever for us to develop and maintain our coping abilities so we can best deal with an increasingly unpredictable environment.
And resilience is key.
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