RESILIENCE

We don’t rise to the level of our expectations; we fall to the level of our training.¹

—ARCHILOCHUS

Taking Archilochus’s, the Greek poet’s, wisdom to heart, the military adopted this credo to train personnel for resilience to perform well under adverse conditions. Under pressure, people default to their training, so trainers repeat the same exercises again and again, until the desired behavior is a habit or second nature.

Whether people volunteered to be put in harm’s way or harm found them, we all need to recover, persist, and even thrive in the face of adversity. For these reasons, resilience is among the greatest moral quests of our time or any time for that matter.

Humans vary widely in how well they respond to stress, pressure, and uncertainty. So, where is the training to which more people could default, since resilience is often the difference between those who succeed and those who struggle?

During the COVID-19 pandemic, the resilience training described in this chapter was offered to more than 2,000 people, ranging from senior leaders to entry-level professionals. It was also offered to people working in sectors other than business—for example, caregivers (physicians-in-training and established physicians); professional and college coaches and athletic performance professionals; and students (medical, MBAs, undergraduates). The goal of this training was to normalize discomfort by preparing for when, not if, things go off the rails.

The strategy was to get the brain to work for, rather than against, us by considering three factors or the 3Rs—regulation, relationships, and reason:

1.   Regulation: Am I safe?

   Regulation starts with homeostasis, which means the body needs stability before it can change.

   Homeostasis involves adjusting one’s physical state, which can be affected by factors like sleep, diet, and exercise.

   Homeostasis also involves one’s psychological response, the drivers of which include factors like anxiety, uncertainty, and fear.

2.   Relationships: Do I belong?

   Relationships are enhanced by trust and compassion.

   Do I feel valued as a person in my team or organization?

   Do I add value to others?

3.   Reason: Do I matter? Do I make a difference?

   When we are well regulated and relationships are sturdy, it is then that we are best positioned to reason well. I am able to effectively manage my emotions.

   Do I feel that my strengths are valued and that I value the strengths in others?

   Do I feel that I make a difference in the lives of others and help other people make a difference in their own lives?

The recurring theme throughout this chapter is that pro-social behavior—that is, behavior that benefits others—contributes mightily to resilience and that virtue is the most pro-social behavior of all. When we intentionally prevent fatigue, strengthen our relationships, and lead purposeful lives, we become more useful when we are most needed.

REGULATION: FEELING PHYSICALLY AND PSYCHOLOGICALLY SAFE

Homeostasis is a key principle of life for all living organisms. First coined as a term by Walter Cannon in 1932 in his book The Wisdom of the Body, homeostasis describes the body’s imperative—tightly regulated—to maintain a steady state in elements like body temperature, serum electrolytes (or salts in the bloodstream), and oxygen and carbon dioxide levels in the bloodstream.² The term homeostasis derives from the Greek words for “same” and “steady,” which capture the essence of homeostasis.

The body likes a Goldilocks solution to its temperature. Not too hot and not too cold, but just right—homeostasis. This is why we sweat to cool when we get hot and we shiver to get warm when we get cold. The body’s temperature will be determined by the balance between the forces generating heat (like metabolic processes and muscular movement) and those that cause heat to be lost (like exposure to cold).

Yet, just as homeostasis is necessary for life, so is change inevitable in life. This is the challenge: how to maintain homeostasis (or return to it) within a process of ongoing change. When we are out of control or dysregulated, we cannot effectively change. When forced to change, people do. Yet, to initiate change takes tremendous mental, emotional, and physical energy. Said differently, when we are emotionally stable, we can better muster the intellectual capacity, the resolve and resilience, and the physical ability to change. Hence, homeostasis and change can—indeed must—coexist.

Everything you learn today determines how your brain will predict tomorrow. Based on past experiences, our brain guesses when to spend and when to save energy. We can get clearer about what we control. We can become more disciplined in deciding what we want to pay attention to. We can self-regulate by developing new habits with sufficient practice. Habits are formed when our brain makes novel connections and prunes itself to make different predictions of the future. Even when our brain inaccurately evaluates our circumstances, it can learn from mistakes and change how we predict the future.³

Think of the brain as the chief financial officer (CFO) for our body budget. In business, a CFO uses the concept of generating and deploying cash for the organization to survive. The brain coordinates overall changes in creating and deploying energy to help the body survive. When we manage energy well, we prevent fatigue and handle stress better. Just as a CFO deploys cash to generate even more cash, our brain deploys resources like water, salt, and glucose to generate even more energy. When we sleep well, eat healthily, and maintain hydration, it is like generating cash that can be deployed later to better function and learn. Like any budget, our body budget has limits. When we spend energy we don’t have, a body deficit limits our ability to function and learn.

We are built to handle brief acute episodes of high-intensity stress. What wears us down is chronic stress resulting from multiple stressors that rarely turn off, such as job pressure, sleep deprivation, and constant electronic device stimulation. Chronic stress can take a toll on our health by weakening our immune system and our mental fitness. How do we cope? Put your CFO body budget—your brain—to work by prioritizing sleep, diet, and exercise.

So, is calm under pressure something you either have or you don’t? While DNA does matter, consider again the word epigenetics. This remarkable concept challenges the old debate about whether we are determined by nature or nurture. Conventional wisdom long held that genes affected human development. Genes were viewed as the independent variable that caused personality. Now we know that our experiences influence genes. So, the answer to the question “Does nature or nurture influence our development?” is yes. Both do.⁴

Taking neurology, genes, and human development back to adversity, we must acknowledge that building resilience and bouncing back is easier for some than for others. Whether our current state is survivor, bend but don’t break, or thrive, here is how we are fundamentally the same. We all benefit from a sense of belonging to people who know us, who love us, and who can calm us. When we feel safe with the people in our families, friends, and teammates, we are amazingly resilient.⁵

RELATIONSHIPS: FEELING LIKE WE BELONG

Connections with others are enhanced when we practice the virtues. For example, relationships thrive when we show compassion.⁶ Interestingly, studies show that compassion shrinks the amygdala, which affects our fight-or-flight mechanism residing in the brain. This is a remarkable finding. When we strengthen the muscles of trust and compassion, we become better humans and, in the process, more resilient.⁷

Our relationships do not need to be Hollywood perfect. In fact, trust deepens as our relationships swing back and forth between rupture and repair. A Harvard longitudinal study showed that even couples who were cranky toward each other lived well, as long as both knew that in a pinch, their partner had their back. The study made clear that trusting and caring relationships reduce the odds that we will get sick and increase the odds of recovery from a serious illness such as cancer or heart disease.⁸

The Harvard study followed 724 men for 75 years beginning in 1938. (Of note, only men were admitted to Harvard College in 1938, so initially no women were included. The study has since expanded to include women and now more than 2,000 children of these men.) Medical records were reviewed, blood samples were taken, brains were scanned, families were interviewed, and employee records were collected. So, what happened? Some climbed the social ladder from the bottom to the top, and others went from the top to the bottom. Some had successful careers and marriages, and others became alcoholics and were haunted by mental demons.

Perhaps you are a 20- to 40-year-old woman wondering how a study of old white guys is relevant. Consider that the key finding was simple and universal—trusting and caring relationships are really good for every human’s happiness and health. That’s it. The study found those who lived life well didn’t have more stuff. They invested in relationships. The quality of close relationships matters more than the quantity of family and friends.⁹ You might also wonder, are you kidding me? It took 75 years to figure out that relationships matter? Well, if this idea is so widely understood, why don’t we invest more in our relationships? Perhaps, the answer is that relationships are messy and complicated, and they require significant effort. Perhaps the answer is relationships often take a back seat to fame and fortune.

By now, we hope it is clear that resilience is not about our circumstances. Our response can help us and those around us flourish even independently of our circumstances.¹⁰ Despite our human shortcomings, we have the ability to guide our behavior by virtue and not be limited by the forces acting on us. The virtues toughen us.

Being tough, not rough—that is our goal. We need toughness to remain resilient and supportive of others in the face of adversity. Paradoxically, we become tougher by practicing the so-called soft stuff like compassion. So, what gets in the way? Things like fear. Even those who excel are not exempt from the barrier of fear, though they manage to weaken its grip.

Fear

“I’m leaving the world of technology and entering the world of Epictetus,” is what James Stockdale said to himself about 30 seconds before he was captured after his jet was shot down over Vietnam.¹¹ Stockdale survived seven years in Hanoi Hilton, a prisoner-of-war camp where he was tortured, starved, and isolated. He credits the Stoic Epictetus in particular and Stoicism in general for saving his life. His experience became known as the Stockdale Paradox:

Retain faith that you will prevail, regardless of difficulties. At the same time, confront the brutal facts of your current reality, whatever they might be. As retired Navy SEAL Brent Gleeson, put it, “Embrace the suck.”¹²

While inspirational, Stockdale’s courage seems out of reach for most of us. We can more easily relate to Michel de Montaigne who over 500 years ago wrote: “My life has been filled with terrible misfortune; most of which never happened.”¹³ Studies have proven Montaigne’s insights to be correct. Humans fear loss, most of which doesn’t actually occur and, if it does, is milder than imagined. The punch line: 97 percent of what people worried about turned out to be no more than exaggerated fear.¹⁴ Our brains don’t distinguish between experiences that are intensely imagined and experiences that are real. So, perspective is lost, while fear and anger spread rapidly. Past dangers and their associated fears stick with us. To extinguish fear, our exposure in a safe environment needs to last long enough for the brain to form a new memory. Once safety is established, we are ready to perform. While it’s not easy to dial back our primitive brain, we aren’t served well to medicalize normal experiences of discomfort with terms like “depression” or “anxiety.” When we do, the point that discomfort is a normal part of life gets missed. And when framed in the right way, discomfort can improve us rather than diminish performance.¹⁵ Let’s be clear: fear is normal. The question is how much priority do we want to give fear? To strengthen our courage requires that we come to grips with our response to risk, uncertainty, and fear. We conquer or at least manage fear by facing it. This is what resilient people do. Winston Churchill reminded us, “When you are walking through hell, keep walking.”¹⁶

We can more easily take on risk in the calm of the day than in the heat of the moment. To this end, teammates can share their hopes and fears before taking on a difficult mission. Each teammate then commits to helping others realize their best hopes and mitigate their greatest concerns. Our brain wants control and stability. So, when we name and discuss our fears with people who want to “en”-courage and support us, we better our chances to conquer our fears. We can’t manage what we can’t name. So, naming emotions is critical to managing them.

REASON: FEELING LIKE WE MATTER AND MAKE A DIFFERENCE

Does stress make us sick? A study tracked 30,000 Americans over eight years, asking how much stress they experienced each year and whether they believed that stress was harmful to their health. Public death records determined who died during the course of the study. People who experienced loads of stress in the previous year had a 43 percent increased risk of death. But, and it’s a big BUT, this was only true for people who believed that stress was harmful to their health. In other words, those who experienced loads of stress and didn’t view stress as harmful were no more likely to die than those who reported little stress. So, if we think stress will hurt us, it will. Time to reframe!

Another study asked 1,000 Americans two questions:

   How much stress did you experience last year?

   How much time did you spend helping friends, neighbors, and people in your community?

Again, public records were used for five years to find out who died. People who experienced significant stress related to events such as family crisis or financial difficulties had a 30 percent increased risk of dying. But again, there was a counterintuitive insight. People who spent time caring for others showed no increase in risk of dying. What is fascinating about these findings is that people who viewed stress as helpful and who took care of others, became courageous and resilient.¹⁷

Here is what is both amazing and hopeful. Changing how we view stress, combined with being well supported and supporting others, can deactivate our amygdala, thus improving our response to stress.

WHY ME? OR, WHAT’S NEXT?

Edie Eger cautions us to be wary of asking “Why me?” She states that “Why me?” is the question of a victim. Instead, she suggests that we ask, “What’s next?,” the question of the liberated. “What’s next?” can be the key to release us from our mental prison. It is a question about the future . . . where hope lives. Fear also lives in the future. Learn to hope instead of fear. It may be surprising to learn that most people become resilient or grow after a traumatic event. About one-third or less get stuck, about one-third stretch like elastic and return to normal after the band snaps back, and about one-third are stronger than before the trauma. They are not necessarily cured, but the trauma and subsequent healing yielded a wiser, braver, and more caring person.

Most of what we have known about trauma is defined as post-traumatic stress disorder (PTSD). PTSD is the inability to move on after an intense traumatic experience, causing the person to continue reliving the experience.¹⁸ PTSD is more likely in a culture that is dangerous or violent, or one in which the person feels ignored.

Decades of research show that most people exposed to violent or even life-threatening events do not develop PTSD. Most people exposed to potentially traumatic events are able to adapt relatively quickly without suffering long-term consequences. For example, a cohort study of over 100,000 soldiers tracked PTSD symptoms before and after military deployment. Nearly 83 percent of participating soldiers experienced few or no PTSD symptoms.

The antidote to developing PTSD is having a supportive social network. James Stockdale said, “True resilience and courage were measured by acts of generosity, compassion, and altruism.”¹⁹ A study of 2,490 Vietnam veterans with low social support found they were 2½ times more likely to suffer from PTSD than those with high social support. Similarly, the lack of social support is twice as reliable in predicting PTSD as the severity of the trauma itself.²⁰ By telling your story to compassionate family members and friends, you are more likely to grow beyond your adversity.

Even for those who experience PTSD, it is important to know it is not a lifelong condition; rather, it is a diagnosis for a specific period of a person’s life. Sadly, fear of PTSD has become greater than the disorder itself, according to Daniela Montalto, Department of Child and Adolescent Psychiatry at NYU Langone Health. We have medicalized our language by saying “I was traumatized,” or “I’m depressed” rather than saying “I had a bad day.” Dr. Montalto said, “Ninety percent of people who develop post-traumatic symptoms have complete remission within eight months. And remember, we’re talking about 90 percent of the 10 percent who have significant symptoms.”²¹

We have made significant progress in not stigmatizing PTSD and encouraging people to receive the support they need. It goes without saying that everything should be done to support people who have had traumatic experiences, whether on the battlefield, in mourning the death of a loved one, or in braving a life-threatening illness. However, our insights are limited when the only perspective we think is possible is PTSD. There is room for tragic optimism that acknowledges the pain we experienced without crushing our spirit.

Psychologist George Bonanno studied people who had experienced the same traumatic event—for instance, soldiers in a platoon during times of war or doctors and first responders during a crisis like the terrorist attacks of September 11. He often found that between one-third to two-thirds of any population seemed to have had no lasting ill effects. This doesn’t mean they didn’t grieve. It does mean their ability to function wasn’t compromised.

So, what do you do for those who struggle? While it is not exactly clear how people bounce back, there does appear to be a path that puts people on a resilience trajectory made possible by a flexible mindset composed of three mutually reinforcing qualities:

1.   A growth mindset makes clear that resilience is a learned skill. We can learn to both accept the brutal facts of our circumstances, while being realistically optimistic about creating a meaningful future.

2.   We are confident in our ability to cope. Confidence is a by-product of applying our greatest strengths to our circumstances.

3.   We think about our circumstances as a challenge rather than a threat. All three combined are more powerful than practicing one without the other.²²

Oddly, even though most people experience resilience and growth after a trauma, the less commonly experienced PTSD is more widely known. For example, a survey revealed that 97 percent of West Point cadets were familiar with PTSD, while only 10 percent had heard of post-traumatic growth (PTG). PTSD can become self-fulfilling when it appears that this is what happens to people after a trauma. In the mid-1990s, research by Richard Tedeschi and Lawrence Calhoun showed that people can experience growth after trauma.²³ Growth does not mean that pain is absent, but rather that trauma’s negative impacts are diminished.

PTG isn’t about glorifying suffering. Statements that trauma builds character feel like total hogwash when we are in the midst of a horrible event. We certainly need more than happy thoughts and pixie dust to get back up after being slammed to the ground. Trauma is the Greek word for “wound.” Rumi, the thirteenth-century poet, offers hope: “The wound is a place where the light enters.” Those like Edie who liberate themselves from their jailers create a place where light enters, enabling the following PTG qualities to emerge:

Empathy: Once we have been knocked to our knees, we can become more understanding and caring toward others who have suffered a tough blow.

Relationships: Big surprise, people like us better when we are empathic. As we become more empathic, our relationships become deeper and more meaningful. When we flex our empathy muscles, we strengthen our relationships.

Purpose: Trauma can lead us to reorder our priorities. We seek a life that involves something bigger than ourselves. Frederic Nietzsche, the German philosopher, said, “He who has a ‘why’ to live can bear almost any ‘how.’”²⁴

Vulnerability: A traumatic event makes it clear that whom we love and what we love can be swept away in a heartbeat. As we become more aware of our vulnerability, we also become more aware of another person’s vulnerability. We become more caring in ways that otherwise may not have happened.

Sense of urgency: Trauma shows us that our life is short, encouraging us to not waste the time that we have. We learn to engage deliberately with the most meaningful parts of our lives while we can.

PTG is cultivated when people feel accepted, feel loved, and have a sense of belonging and connection.²⁵

In other words, individuals can start to look forward when they are part of a safe place, a place where people find words to capture their feelings and where their trauma won’t be held against them.²⁶ Now, the possibility of achieving PTG shouldn’t endorse blaming people who experience post-traumatic stress. Events that befall us are not necessarily our fault, though ultimately, notes Viktor Frankl, “when we are no longer able to change a situation, we are challenged to change ourselves.”²⁷

CRISIS: SMALL T AND BIG T TRAUMA

Knowing that trauma means “wound,” we know if we live long enough, we will experience “small t” and “big T” traumatic events. When it comes to collective trauma, 2020 was a whopper. The world hit the trifecta of a pandemic, a global recession, and social unrest caused by racial injustice. Travel plans were kicked to the curb, businesses were shut down, and kids were removed from school. Physicians and nurses worked around the clock, some businesses and jobs did not come back, and, sadly, many people died in isolation from loved ones. Global trauma has continued with the pandemic through 2022, when the trauma of COVID-19 and social injustice was compounded by the Russian invasion of Ukraine and the humanitarian crisis that ensued. There is no shortage of trauma, and no one escapes it. And now we face the potential trauma of climate change.

The trauma of COVID-19 created a shared experience of uncertainty. Among the many inequities laid bare by the pandemic were the differences in the ways people navigated the pandemic. Greg Boyle suggested some folks traveled the coronavirus waters on an ocean liner, some in a rubber boat, and some clinging to a piece of driftwood.²⁸ Those on the ocean liner had to limit their interactions, though their jobs and pay remained intact while they worked relatively safely from home. At the same time, houses were upgraded thanks to carpenters, toilets flushed thanks to plumbers, and store shelves were stocked thanks to truckers and retail staff. Those in rubber boats had their lives turned upside down, doing jobs that put their health at risk. Those clinging to driftwood battled to hang on to their jobs and lives. And many lost their lives.

Whether 2020 was a big T or a small t trauma for you, shared adversity raises a question that defines the human condition: what are our responsibilities to each other? Two behaviors emerge during disasters: fear that breeds conflict and solidarity that generates collaboration and commitment. We can expect the best more than the worst in most people. Our mental health improves when situations require sacrifice, which strengthens our need to connect and work together. At our best, emergencies increase our need for social solidarity to survive. As a result, selfish instincts and individual differences melt away when the only way we can survive is by relying on each other. COVID also laid bare our dark side with outcries over systematic racism and political instability flamed by misinformation and mistrust of our institutions and leaders. However, the bleak side of human nature is never the whole story. Most people understand that a crisis calls for caring and collaborating with strangers.²⁹

So, why are most people transformed to embody compassion, courage, and hope during a tragedy? During normal times, we are just living our lives. We don’t spend loads of time thinking about our obligations to others. In fact, busyness can be the next best thing to having a purpose. In contrast, a crisis forces us to become more reflective, wiser, and focused on others. When we look out for each other, we learn some resilience for ourselves, so the world won’t topple us easily.

Here is what doesn’t build resilience: my big T or small t trauma is worse than your big T or small t trauma. Heartache isn’t a competition. Misery and fragility are well fertilized by being aggrieved and entitled. Here is what does build resilience—a moral compass fortified by people who bring out our best self. People who strengthen our courage even when we feel like we will buckle. After watching neighbors take care of each other after the 1906 San Francisco earthquake, Dorothy Day wondered why people can’t treat each other this way all the time?³⁰

We will end a chapter on resilience by looking at a small t trauma experience of job loss. While not often life-threatening, losing a job is a significant wound nonetheless. In 1981, the term hardiness emerged from a 12-year longitudinal study of Illinois Bell Telephone employees after a layoff. Legislation swept away the company’s monopoly and tossed everyone into a hypercompetitive pool without swimming lessons. The economic disruption that ensued devastated some Bell Telephone employees but invigorated others. Why did the same event affect people so differently? The answer was “hardiness” defined as commitment to the task at hand rather than dwelling on what was lost; belief that there are conditions that can be controlled; and the ability to see the circumstances as a challenge rather than as a threat. Since this study was completed, hundreds of studies have confirmed that hardiness converts disruption and potential disasters into growth opportunities.

Hardy people believe they are involved in meaningful work and that they have agency to affect change, and they view success and failure as the path to learn and grow. Hardy people learn to accept the world as it actually works, not as they want it to be. In contrast, the fragile yearn for a world that never existed and struggle to accept the reality of their circumstances. Hardy people push forward with the view that going backward is not an option. However, people must be hardy with humility. Forcing the reluctant to jump into a moving river when they are not ready will go about as well as you might expect. At the same time, the hardy need to make clear that you can’t stay on the riverbank where you are now.³¹

Think of Edie’s question, “What’s next?” as the way to understand the details of hardiness. Commitment implicates a sense of purpose and meaning in life. Hardy people view change as an opportunity to live life well. They see their work as important and worthy of their best efforts and creativity. They are gritty; they have a deep sense of purpose, which drives persistence. They view withdrawal from stress as weak and stepping into stress as strong.

There are lessons for leadership here too.³² A resilience study of 25,000 adults working in 25 countries revealed that neither gender nor nationality determined how well a country had handled the COVID-19 pandemic. Instead, the more clearly the leaders defined the threat, the more resilient their people became.

The implication for leaders is that there is no need to sugarcoat brutal facts. When threats are clearly defined, resilience kicks in.³³

During COVID-19, many people experienced disruption in their routines, loss of financial security, and disconnection from teammates, friends, and families. Events are objective though our interpretations are not. Our interpretations are a guess or a story as to what happened and what it means. The story we tell ourselves influences whether we react with anger and fear or understanding and forgiveness. Do we yell at our teammates, or do we listen and coach? In every situation, we can find a better story to tell ourselves. Applied to COVID-19, we can create a constructive story by asking questions such as these:

1.   During COVID, what was the greatest loss you experienced?

2.   During COVID, what was the greatest gain you experienced?

3.   Upon reflection, what did you learn about yourself?

4.   What would it look like if you applied your greatest areas of growth from COVID to your future?³⁴

At this stage in the book, it should come as no surprise that employees in organizations that help their people face significant challenges feel more satisfaction and commitment to their work and experience less burnout and absenteeism. The importance of pro-social behavior defined by virtue replaces angst with a sense of belonging. In 2022, an unpublished study that involved Oxford and Harvard Universities showed that a treatment group that practiced the virtues significantly reduced anxiety and depression while angst and depression in the control group continued.

The door that opens to optimism is agency or free will, at least the belief in free will. The best way to open this door is caring for others—being empathic. We better handle discomfort, lower angst, and improve performance when we focus on others. In music, this is called the empathy shift. At first, a violinist gets better at their craft when tutored by a skilled teacher. The teacher amps up discomfort by having the violinist practice with an orchestra. They see if they can squeeze even more out of the violinist when they experience discomfort in front of a live audience as part of an orchestra. At each step, the violinist plays better, but their performance is suboptimal until they make the empathy shift, which means that they start to listen to the sound of fellow artists, not just themselves. When they make this empathy shift, their performance improves.³⁵

In sum, the hardy teach us that if we practice fear, we multiply fear. If we practice resilience, we grow resilience. If we practice virtue, we get better at who we are, and we get better at what we do.