By Abby R. Rosenberg, JAMA Pediatrics, April 14, 2020

Coronavirus disease 2019 (COVID-19) is affecting our health care community in unprecedented ways. As a pediatric oncologist who studies resilience in the context of illness, I started thinking about what this pandemic means for our professional resilience a few weeks ago, when the first US patient with fatal COVID-19 died in my home city of Seattle, Washington.

Promoting resilience among health care workers and organizations starts with understanding what resilience is (and what it is not). Historical psychology and social science suggested resilience was either a trait (eg, hardiness), a process (eg, adaptation), or an outcome (eg, the absence of posttraumatic stress or the presence of posttraumatic growth after a particular adversity). The first and last conceptualizations are questionable. The potential for resilience is not a unique trait that one has or does not have; the capacity for resilience is inherent in all people. Resilience is not a single dichotomous outcome measured at a point; we can simultaneously experience posttraumatic stress and growth, and these (and other) outcomes dynamically evolve throughout our lives. Finally, both trait and outcome conceptualizations suggest resilience is something that happens to the fortunate and something we can hope for but not necessarily achieve. This is incorrect. Resilience is neither lucky nor passive. It takes deliberate effort. Indeed, while resilience researchers have quibbled over nuanced definitions and requirements for resilience, they agree that it can be strengthened with practice.

Modern psychology and social science define resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress.” For years, I questioned the qualification of the word well. Who defines wellness, and what is well enough to meet the threshold of resilience? My questioning stemmed from a conversation I had years ago with a parent who was bereaved. They said they were resilient because they had gotten out of bed that day, because they were putting one foot in front of the other and continuing the hard work of living without their son. I thought, “Yeah. That seems pretty resilient. I’m not sure I would be able to do the same.” I concluded that resilience was about adapting—the wellness part was optional.

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