Introduction A parent and three children, one just a toddler, set out on the short walk to school. For them it is a day like any other, and then suddenly it changes. Something catches the attention of the youngest child, just two years old, who slips from the grasp of the parent and darts out into the road. An accident resulting in quite serious injuries. A cataclysmic change in circumstances for that family. What happens next? Here is one scenario, and it could easily happen. A concerned neighbour hears the accident and runs out to help, gathering up and reassuring the two older children. The ambulance arrives quickly and takes the parent and toddler to hospital. The neighbour looks after the children and rings the workplace of their other parent, whose employers immediately offer time off to attend to the needs of the family. Phone calls to school and to grandparents make it clear that there will be plenty of strong support for the family for as long as it takes for the injured child to recover. Another scenario is equally possible. The parent has no involved partner, and lives in an area where neighbours are distant or even hostile. Grandparents try to be supportive but are fully occupied with serious health issues of their own. The ambulance staff arrange for the parent to get to the hospital with the other two children, but once there a choice must be made between seeing the social worker to try to arrange temporary foster care for the older children so that the parent can stay in hospital with the toddler, or leaving the toddler alone on the ward so that the parent can go home to look after the older children. This family is at risk of disintegrating as the result of an accident that may occur to anyone at any time. Resilience is the ability to adapt well to risk and challenge, to survive and thrive under difficult conditions, and it is as vital to mental and emotional health as a sound immune system is to physical health. So what makes people resilient? How can we promote resilience in individuals and in society? And what are the links between resilience and what happens to children in the early years of life? It is important to understand some key points about current research and theory in order to make sense of our two stories and begin to find answers to these questions. On that day, at that time Firstly, resilience is linked to, and shown through meeting, a particular risk or challenge. Resilience is not a quality or set of qualities existing separately from the events of life. The people involved in the stories do not live in a vacuum. How each of them responds to this very challenging event will be affected by factors that have nothing to do with the accident, but which will influence the outcome. If we take the parent in each of the stories, for example, many factors will contribute to how resilient they are on that day at that time. Physical health or the lack of it, having had a good night's sleep or being tired or exhausted, whether the preparations for getting out to school had been peaceful or troubled and chaotic, previous experiences the parent may have had of accidents or injuries, and so on. A wide range of possible factors influence the capacity of that person at that time to adapt and respond to a severe challenge. The social context of resilience Secondly, resilience is always partly about the individual and partly about the social context in which they find themselves. This is amply illustrated by our two stories. In the first scenario every individual involved is within a social context in which the challenge that faces them can become a growing point. Each of the individuals is unique, with a combination of personal qualities and individual experience that on that day at that time makes them more or less resilient in the face of this particular challenge. The strong supportive social network around this family means that each of these unique individuals has the best possible chance of discovering reserves of resilience in meeting the challenge, and in doing so these reserves actually increase. Resilience, like love, increases through use. And in such a scenario it is not only the immediate family members who may exercise and therefore increase their resilience. As well as both parents and all three children having this opportunity, the grandparents, the neighbour, the ambulance staff, the school staff, and even the employers of the second parent, are all presented with a challenge which can activate and extend their own resilience. The second scenario presents a very different picture in which there is much greater risk that individuals will be overwhelmed by a challenge that is greater than their resources of resilience. In those circumstances each of the individuals is diminished rather than strengthened. Challenges always change us. Resilience and trauma A third important aspect of resilience is therefore the close interactive relationship between resilience and trauma. Trauma means injury, and in the context of current research on the development and function of the human brain, the word trauma is also used to refer specifically to brain injuries acquired as a result of unregulated stress. Human beings have large and complex brains which enable us as a species to be wonderfully (and sometimes fearfully) inventive and productive. Yet when confronted with a threat to life this large and complex brain can be a slow and cumbersome response mechanism. Stopping to think before we act, when under extreme threat, may mean that we never have the chance to stop and think again. The human brain has a survival response, however, that has kept us in existence as a species. A threat to life can cause the brain to turn itself off, reducing any functions which slow down response time. Extreme stress is the trigger activating this cut-out switch in the brain. But the brain cannot distinguish between extreme stress induced by a threat to life, and extreme stress from some other cause. One feature of resilience is that it enables people to manage their own stress levels. So resilient people are less likely to be traumatised by stressful events. But everyone is vulnerable to trauma – this innate stress response is universal – and if an event does overwhelm the ability of that individual to self-regulate stress, then the resulting trauma destroys their resilience. So resilience protects against trauma, but resilience is also destroyed by trauma. What are the links between resilience and the early years of life? This understanding of the interaction between resilience and trauma leads to us to consider a fourth key aspect of resilience – the links between resilience and experience in the early years of life. Humans are not born able to regulate stress. At birth the brain is very unformed. Nearly all the brain structures that enable human beings to function are acquired during the first three years of life, when the brain grows and organises itself at an astonishing rate. Many of these structures in the developing brain are laid down as patterns in response to the behaviour of the adults caring for the young child. Relationships really do build brains in the early years. The ability to self-regulate and to manage stress is one of these patterns in the brain acquired as a result of what the adults around the baby do. Babies and their carers attune to each other. When the baby's inner state changes, for example when they are distressed or frightened, they produce what are called attachment behaviours, which provoke a response in the adult. Then the inner state of the adult changes to match that of the baby. Since the adult is able to change their own inner state at will, self-regulation in the adult means that the attuned baby then in turn changes to match the new inner state of the carer. So if the baby becomes stressed the adult becomes stressed. Then the adult self-regulates to reduce the stress, and the baby's stress level also reduces. This builds a pattern in the brain for the self-regulation of stress. The older children in our two stories may be able to manage the stress of this severe challenge, and they will also be able to draw on the resources of trusted adults to help them to manage this stress. So the children in the first scenario are more protected from trauma than those in the second, because they have more social resources around them to help them. In both scenarios, the toddler will be much more dependent on the parent for stress regulation. In the first scenario the parent has the best chance of being able to access their own resilience, to regulate their own stress level, and therefore to protect the young child from being harmed by stress. The parent in the second scenario is more vulnerable to being overwhelmed by the stress of this event because of the lack of social support, therefore both the parent and the toddler are more likely to be traumatised by the accident than the parent and child in the first version of the story. What makes people resilient? We have seen that individual resilience consists of a set of dynamic qualities activated by exposure to risk or challenge and reinforced and strengthened by successful adaptation to experience. Some of these qualities will be innate – temperament and intelligence, for example, affect our capacity to adapt to a range of challenges. Many of the qualities that provide the resources for resilience are acquired in the early years of life. People who have secure core assumptions about the world and other people are more resilient. Such core beliefs enable people to feel safe enough to function from day to day, to trust other people to help them at need, and to have confidence in their own worth and value, are set down as patterns in the brain through myriad interactions between the young child and their key attachment figures. These core assumptions are shattered by trauma, destroying resilience, but can be built or rebuilt through healing relationships at any stage of life. People also tend to be more resilient if they have a problem-solving approach to any adversity, if they have good social skills and communication skills,and if they have a sense of purpose and future. All of these can be learned at any stage of life, and can also be relearned if diminished as a result of trauma. It is also clear that individual resilience factors are only part, sometimes a small part, of the whole picture for anyone having to adapt to challenging events. The social context in which the events occur is also crucial to the outcome. To be part of a secure social network with well-formed attachment relationships is an important resource for resilience. As our stories showed, such factors can make the vital difference between a successful outcome and disintegration. How can we promote resilience in individuals and in society? Resilience, that vital ingredient of mental and emotional health and well-being, requires a social order in which there is a healthy balance between safety and challenge. Promoting resilience involves ensuring that individuals and families and whole communities receive the support and encouragement they need to become sources of support and encouragement for others. A resilience-led approach tends, according to Robbie Gilligan's excellent book on the subject (BAAF, 2009), to be 'optimistic and pragmatic'. Resilience provides hope. It also demands that we each take responsibility for our own contribution to promoting the resilience of the individuals, families and communities in which we find ourselves. Some years ago, hurrying through driving rain in central London to deliver a lecture, I slipped and fell. When I picked myself up blood was pouring down my face and my clothes were sodden and muddy. I managed to limp two hundred metres to the venue. I passed scores, perhaps hundreds of people, and not one offered any comfort or help. When I reached my destination I staggered in and asked the attendant for first aid. He told me the hospital was round the corner. I explained that I was due to deliver a lecture that day, but just needed first aid because I had fallen and hurt myself. He came out from behind his desk. "Perhaps you do need first aid" he said, "but before that you need a big hug!". A prescription he immediately delivered. He was right – he could have been terribly wrong, but he took the risk because this human response came from his very core – and I was quickly able to recover from the accident. Falling was a challenge. Being ignored depleted my resilience. Being cared for by a kind stranger restored me to my full resourcefulness. Once we realise that every action we take, or omit, may be the one that creates the turning point for someone between adapting and disintegrating, then we must recognise that every one of us has a vital role to play in building resilience, a role which will require us to step up and act. Some useful books Cairns, K (2002) Attachment, Trauma and Resilience: Therapeutic caring for children, BAAF Gilligan, R (2009) Promoting Resilience: Supporting children and young people who are in care, adopted or in need, BAAF Schoon, I (2006) Risk and Resilience: Adaptations in changing times, Cambridge University Press Kate Cairns Associates
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