Fostering Resiliency After Trauma

"Inner Sight," by Alexei von Jawlensky, 1928.Private Collection. Resilience involves developing a recalibrated perspective–an "inner sight."

Source: Photo credit: copyright Christie's Images/Bridgeman Images. Used with permission.

One morning several years ago, NY Times columnist and now a professor at Duke University, Frank Bruni, woke up with a “blob of jelly” over his right eye.

What seemed like a temporary Vaseline-like smear affecting his vision was NAION: non-arteritic anterior ischemic optic neuropathy. At age 53, Bruni had suffered a stroke—inadequate blood flow to his optic nerve–that compromised his eyesight. Words on a page became a “sludgy gumbo of fuzzy letters and word clusters.”

Those who follow Bruni’s editorials in the Times will remember he has written powerfully about his sojourn through an extensive diagnostic work-up, including visits to neuro-ophthalmologists. He learned that this type of damage to an eye is permanent and does not improve.

Furthermore, hanging over him is a potential “ocular Armageddon”—another similar stroke can affect his other eye. Each morning since the stroke happened overnight, he awoke with a “stab of suspense.” Medical research, though, offered some hope.

Ultimately, Bruni endured two unsuccessful clinical research trials as an “ophthalmological guinea pig,” one of which included being subjected to injections administered directly into his afflicted eye and the other, self-injections in his thigh or abdominal area twice a week for six months with medicine made from the resin of a gnarly mastic tree grown on the Greek island of Chios.

Bruni has recently published The Beauty of Dusk: On Vision Lost and Found (2022), a book that grew out of his experience, not only with being given this life-altering diagnosis but with experiencing the simultaneous break-up of a ten-year relationship as well as his father’s incipient dementia.

Pointedly, among the many specialists he consulted, no one, said Bruni, inquired about his mental health. "Doctors are only human," he concluded charitably. He coped so well that no one seemed to notice or dwell on his disability—what he called the “camouflage of normality.”

French School. "The Sandwich Man, Boulevard du Temple," 1839. A sandwich board was an inexpensive way to advertise in the 19th century. Many people can create their own 'sandwich boards' that reveal pain, trauma, disease.

Source: Photo credit: Bridgeman Images. Used with permission.

We all have our own “sandwich boards,” says Bruni. A sandwich board was an inexpensive form of advertising popular in the late 19th century (Oxford English Dictionary). It consisted of two placards fastened together with straps supported on the shoulders of those carrying their signs.

Men would travel up and down the street to promote what they were selling (Encyclopedia Britannica). In Bruni’s parlance, a sandwich board alerts those around us to our personal difficulties, hardships, or pain we have to contend with and which others do not or may not know.

Bruni’s own sandwich board would read: “Eyesight compromised, could go blind.” We are “a breakable species,” says Bruni, and there is often a vast difference between the “public gloss and private mess.”

Though we are indeed a "breakable species," remarkably many, including Bruni, display enormous resilience in the face of a terrible diagnosis or other unfathomable traumas.

The notion of resilience, for example, is not far from any of us as we watch the gruesome events unfolding in Ukraine and see the plight of millions of people displaced from their homes, separated from loved ones, and witness to unimaginable death and destruction.

We marvel at President Zelensky, who was offered the chance to flee his country and refused, and his fellow citizens who remain and rise against the onslaught of overwhelming Russian aggression.

There are degrees of trauma, and I am hardly equating the mass horrors experienced by millions of Ukrainian people with one personal experience. The principles of withstanding trauma, though, are similar.

Resilience is our ability to adapt to and weather adversity (Liu et al., 2018; Southwick & Charney, 2018). It does not mean being unaffected by adversity: "a resilient person may be deeply affected by a traumatic event and may even experience psychological symptoms...but it does mean being able to carry on with the important facets of one's life" despite painful reality and distress (Southwick & Charney, 2018).

Resilience may also entail growing from the experience and being able to find meaning and purpose.

"Open-Eyed Group," by Swiss artist Paul Klee, 1938. Private Collection.

Source: Photo Copyright Christie's Images/ Bridgeman Images. Copyright 2022 Artists Rights Society (ARS), New York. Used with permission of ARS and Bridgeman Images.

Further, resilience reportedly, and perhaps surprisingly, is more a "common phenomenon rather than an extraordinary process" (Cathomas et al., 2019; Roeckner et al., 2021) though it is "best conceptualized as a continuum" (Feder et al., 2019).

For example, researchers have debated whether resilience is a trait, process, or outcome, but whether it is a trait reflecting a "constellation of characteristics," a dynamic process that emphasizes change over time, or an outcome after exposure, it always involves thriving in the face of adversity (Liu et al., 2018).

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Different genetic variants likely contribute to resilience, but genetic-environmental studies have yielded inconsistent results due to differences in assessing environmental risks that involve timing, type, and duration of adversity and differences between self-reports and objective measurements (Elbau et al., 2019).

Researchers are also just beginning to explore the neurobiological-physiological underpinnings of resilience, including areas of the brain that offer either protection or suggest vulnerability (Roeckner et al., 2021; Cathomas et al., 2019; Watanabe & Takeda, 2022).

Psychological factors associated with resilience include a sense of optimism, strong social support from others, and a cognitive reappraisal of events (Liu et al., 2018). Being able to know when to request help is also important. Bruni, for example, has a wide network of friends, colleagues, and family he could call on, as well as a beloved dog.

He was also able to "alchemize misfortune," i.e., recognize "slivers of happiness" despite the adversities he faced. He could maintain a perspective, including a keen sense of humor, to recalibrate and reorient rather than define himself solely by his limitations.

"Animus Sketch," by Chinese-American artist Diana Ong, 2007. Computer graphics.

Source: Bridgeman Images. Used with permission.

"Ultimately, resilience is about understanding the difference between fate and freedom," (Southwick & Charney, 2018). It is one of life's paradoxes: “We have no control over life; we have control over life,” wrote Bruni.

Zelensky has embodied this understanding: he has effectively reached out for help and has rallied the world in his quest for the freedom of Ukraine.

In refusing to accept fate as inevitable, he has become an international symbol of resilience.