Hawyee here. This is an expanded version of a talk I gave at on 18 November 2012 at In Her Shoes, a festival of art and music that supports the fight against cancer. My five-minute talk was part of a larger presentation by Benjamin Yang, one of the directors of the Positive Psychology Centre, on The Science Behind Our Happiness.
After my stroke in May 2011 in which I lost the use of the left half of my body, in my journey through the various medical establishment, in setting up the RACHEL fund and then this blog subsequently; I had the opportunity to talk with many fellow travelers and stroke patients, and the various ways people reacted to and coped with their traumas became a nagging puzzle for me.
In my case, I lost the use of the half of my body that included my dominant hand, and still managed to get back to work within 3 and a half months of the stroke, so I was curious as to why some people whose disabilities were less serious than mine nevertheless seemed to be stuck and unable to move on.
I first asked my occupational therapist about this puzzle seven months after my stroke. He was the principal occupational therapist at Tan Tock Seng Hospital’s Centre for Advanced Rehabilitation Therapeutics (CART), with 14 years of experience under his belt. He explained to me that disability was unfortunately never a purely physical phenomenon, and that the extent of disability depended very much on the patient’s psychological resilience and reaction to his/her condition.
What is resilience?
There’s been a spike in interest in resilience research recently, driven by several high profile natural disasters (eg Hurricane Katrina; the Tohoku earthquake, tsunami, and subsequent nuclear meltdown at Fukushima), and, more recently, the near collapse of the global financial superstructure in 2009. Most of this interest is in the resilience of systems, but since systems are ultimately made of people, I think the smallest meaningful unit of analysis is the individual, and I hope to share with you some characteristics of individual resilience that I’ve uncovered through research and personal observation.
Let’s start with a definition of resilience. Andrew Zolli, executive director and curator of PopTech, co-authored a well-received 2012 book with Ann Marie Healy on resilience. In an interview with The Atlantic Magazine, he explains that resilience can mean different things in different contexts, but two essential characteristics of resilient systems is the ability:
[for] continuity and recovery in the face of rapid change…Among other things, resilient systems sense and respond to their own state and the state of the world around them, compensate or dynamically reorganize themselves in the face of novel shocks, decouple themselves from other fragile systems when necessary, fail gracefully, and have strong local self-sufficiency.
The human body is at once an amazingly fragile and an astonishingly resilient biological system, and one can quickly identify how the human body has many characteristics of a resilient system as Zolli points out.
What I want to share instead in this essay are five traits that I’ve observed to be essential in building psychological resilience. I’ve taken Benjamin’s advice to be as explicit and as unambiguous as possible so that others might benefit when reading this.
1. A sense of purpose
A sense of purpose is important whichever stage of life you’re in. Some people get their sense of purpose from religion. Others, like me, don’t. A sense of purpose doesn’t need to come from grandiose ideas about saving the world, and can come from even simple goals like achieving a certain minor milestone in rehabilitation. Or it can be even simpler, like getting up to go to work at the same time every day. When I was discharged in July 2011, I told my therapist that I would be back at work in September. She advised against it. Looking back, I was still probably a bit too weak to have gone back to work when I did, but the simple goal of having to make it to work and then back home again by myself everyday (even if I was avoiding public transportation) proved to be a strong antidote against just staying in bed and feeling sorry for myself.
Of course, not going back to work so soon in order to focus on rehabilitation also works if you’re the highly motivated sort. My physical therapist tells me stories of his two patients who have not gone back to work yet, but who dedicate 4 hours every day to exercise and are making tremendous progress as a result. This has in turn inspired me to dedicate for 2 weeks’ leave this December to intensive training.
2. Focusing on what you still have, not what you lost
For me, being grateful for what I still am able to do and for minor accomplishments keep me from falling into depression and help me achieve longer term rehabilitation targets. Some patients I speak to obsess with the things they can no longer do, instead of what they could possibly achieve with what they have left. I’ve always been a fan of the (albeit fictional) master improvisor McGuyver from the 80’s television series of the same name. It’s been surprising the number of things I can still do one-handed—for eg taking apart my Apple Mac Mini to install a new hard drive, or (more mundanely) clipping my own fingernails. The only psychological barrier I needed to overcome was an aversion to looking awkward or silly as I struggle [Tip: BlueTac is your best friend when you have to do things one-handed].
In particular, I’m grateful that I still seem to have the full use of my cognitive faculties, even though I’m speaking slightly slower and more prone to frustration sometimes.
When I was first transferred from Tan Tock Seng’s main acute hospital to their community hospital in Ang Mo Kio, the resident psychologist paid me a visit to do an initial assessment. She kept asking me why I wasn’t depressed, perhaps out of concern that I was in deep denial. I found that quite amusing. What she didn’t understand was that I had the good fortune to inherit my father’s attitude of always looking on the bright side of things; which really helped in the recovery process.
3. Non-internilization of others’ perceptions
As one comes to terms with a fresh disability, it’s vital to have a mental distinction between your own self image and others’ perceptions of you. Just because some people might see you as disabled doesn’t mean that you are.
When I was in university, I spoke with my dorm-mate’s Chinese mother about racism in the US. We eventually got around to talking about racial slurs.
“Would you feel insulted if someone called you a ‘chink’?” I asked.
“Of course, because it’s rude,” she replied.
That got me thinking: Isn’t the use of the pejorative ‘chink’ more indicative that the person using it is a racist ass rather than it is denigrating for the person on the receiving end?
Similarly, I’ve observed that some people internalize how others perceive them; instead of interpreting these perceptions as a reflection of the originators’ ignorance—which should be the appropriate interpretation.
4. Availability and acceptance of social support
Human beings are social animals. Unless you’re a psychopath, the need for social interactions is deeply embedded within our psyche; however tempting it might be to think that we are individual supermen or John Galt from Ayn Rand’s Atlas Shrugged.
There’s no shame in seeking or accepting social support, and the act of acceptance of support can even do the giver some good. Benjamin wrote in a short note on Facebook a few weeks back:
Very often, many of us are ready to give. But how many of us are ready to receive? In many ways, the act of receiving is just as important as giving. By receiving, we are in essence an instrument in completing the act of kindness.
5. Optimism tempered with realism
Optimism is tied closely with all of my earlier points. It’s an attitude that helps with all the others. For example, having a positive frame of mind helps when seeking out and when interacting with company; and helps to you to identify and be thankful for the things you still have.
The caveat, though, is that it has to be an optimism that is tempered by a sense of realism. Unrealistic optimism can be extremely disheartening when reality inevitably sinks in.
For his book Good to Great, Jim Collins interviewed admiral James Stockdale, the highest ranking US soldier to be held prisoner during the Vietnam War. Stockdale survived 8 years of torture and lived to tell his tale. When Jim Collins asked him about the prisoners who didn’t make it out, Stockdale said:
“[They were] the optimists. Oh, they were the ones who said, ‘We’re going to be out by Christmas.’ And Christmas would come, and Christmas would go. Then they’d say, ‘We’re going to be out by Easter.’ And Easter would come, and Easter would go. And then Thanksgiving, and then it would be Christmas again. And they died of a broken heart.”
Stockdale’s answer shows how important it is for optimism to be tempered with realism. In trying to live this value, I think of rehabilitation as a journey of constantly getting better, and not as a means to reach a specific stage of recovery.
[The Stockdale paradox]
Stockdale’s story is in many ways so astonishing that I want to talk a bit more about it here. His ability to combine realism with optimism was so puzzling that psychologists called it the ‘Stockdale pradox’. In an interview with Dr Dennis Charney, a psychiatrist who is looking to find new treatments for depression, Stockdale explained that his source of optimism came from the social support that get got from the other prisoners. Even though they were all in solitary confinement, they worked out a method of using taps to communicate through the prison cell walls. Dr Charney further elaborates:
The Stockdale Paradox really defines the optimism that is most important in becoming a resilient person and that is, when you’re faced with a challenge or a trauma, you look at that challenge objectively. You might make the assessment, ‘I’m in really big trouble.’ You have a realistic assessment of what you’re facing. On the other hand, you have the attitude and the confidence to say, ‘But I will prevail. I’m in a tough spot, but I will prevail.’ That is the optimism that relates to resilience.