By Nomi Levy-Carrick, MD, MPhil

The Boston marathon was delayed and, in its stead, we are asked to engage in a totally different test of endurance. Instead of running a distance, we are keeping our distance. Instead of counting the miles, we are counting the days. Instead of reveling in the crowds among strangers, we are sheltering in our homes among familiars. Crossing a finish line we cannot see, whose distance we do not know, will require a different kind of effort.

Resilience is an umbrella term that captures a broad array of traits that help people “bend, not break” under the weight of a stressor (acute or chronic). Many components of resilience were established long before this latest challenge: social networks, a sense of humor, a sense of meaning and purpose. Others will be in varying states of repair: diet, exercise, sleep. And still others can be acquired: role-clarity, self-efficacy, and empowerment. There are also social determinants of health that determine where we fall on the spectrum of vulnerability and resilience whenever adversity arrives.

Resilience is an umbrella term that captures a broad array of traits that help people “bend, not break” under the weight of a stressor.

Our penchant for stories focused on individual acts of heroism can make it hard to remember that those heroes most often exist within a rich network of partners, supporters, and mentors. To get through this COVID-19 crisis, we must enforce physical distancing, but to conflate that with social isolation is to undermine a fundamental building block of human survival.

What does that mean for health care workers at the front line?

We need to explicitly recognize that the only way through is with multidisciplinary teams in which every member is valued. The oft-used language of “essential” and “non-essential” personnel in preparedness planning, for example, inadvertently underappreciates the infrastructure required to do clinical work. Even as I write this late into the evening, my administrative team is working alongside me pulling together the lists, templates, and other components of program development that will operationalize a plan.

What does this mean for individuals?

Even a marathon champion is not an army of one. They have trainers, family support, and communities behind them. We need to remember every day, perhaps every hour, that we do not need to hold the burden of decisions alone. Where do we find the psychological safety to discharge unfiltered frustrations of the day, in order to achieve a catharsis or perspective that helps us face the next? How does one balance the need for autonomy with that of collaboration?

How do we move forward?

Here are three strategies:

1. First, be able to name what is distressing in real time. In doing so, we can make small adjustments to change the overall trajectory of the journey. The runners’ muscle cramp is a clinician’s moment of cognitive overload. The shin splints, a sign of repeated trauma, evidence both of determined effort and debilitating strain. It is recovery, not endurance, that determines whether you get to the finish line. Pull out that “emotional vocabulary wheel” and remember that our inner lives are more than just sad-mad-glad.
2. Second, insist that you should never worry alone. Everyone gains when complex problems are considered from multiple perspectives. If you can’t put your head on the pillow at night and rest easy because of a situation at work, you were at least one conversation short of resolution. Figure out with whom you will have it the next day, maybe even schedule a time. Many situations have no right answers, or no answers at all — but there is tremendous power in sharing the narrative, allowing contextual processing to temper the intensity of direct exposures and potential vicarious traumas.
3. Third, maintain a sense of purpose. We can bear adversity in astonishing measure if it doesn’t feel gratuitous. There is a great threat of moral injury in disasters — triaging amidst limited resources; fearing putting others at risk (is it fair to take a chance of spreading this to my family?); watching suffering that might have been averted “if only.” At these moments, having role clarity can be re-centering. What can I do here, right now? What can I control, and what is beyond my control?

If one allows for the possibility that every experience — even the worst ones — can focus the effort to effect change beyond the bedside, it introduces the potential for post-traumatic growth. Recognizing that we have an opportunity to be stronger (in ways we may not even imagine) by surviving this adversity, we learn, we teach, we care, and we endure.

Nomi Levy-Carrick, MD, MPhil is the Associate Vice Chair, Ambulatory Services, Department of Psychiatry at Brigham Health in Boston, MA.

Header illustration by solarseven / iStock