Resiliency: Fascinating complex topic… There are a number of key elements that predict resiliency, #1 being Genetic: We have 2 arms of the serotonin transporter gene, long or short…. 2 short arms are bad, 2 long good. If someone has little or no abuse as a kid, they may do well even with 2 short arms BUT, with abuse (sexual, physical, emotional…. stressful childhood) the expression of these genes results in a dysfunctional adult, often borderline. This has been used in monkey experiments, where monkeys with 2 short arms are given a bad childhood (no mom), and they end up biting and hissing, asocial, sitting in the corner. When monkeys with 2 long arms are given a bad monkey childhood, they usually are ok, fine. This helps to explain why 18% of kids with severe abuse end up pretty good. There was a marvelous NY Times article on this, “A Question of Resilience”.

Of course, it is not all nature, nurture comes into play, with modeling of resilience by parents, and parenting styles, etc. A warm supportive (but not enabling) environment helps. Cultural factors play in, with some cultures being more accepting of disability/underfunctioning. Does our easy Social Security environment encourage low functioning?  Sometimes. Psychiatric factors are important, as those with comorbid depression/anxiety/personality disorders, in addition to the pain, may be less resilient.

So, what can we do with our patients to foster/enhance/create resilience? We can encourage functioning (working, going to school, volunteering), exercise, yoga, getting out of the house. We can discourage disability. We can push psychotherapy, and work with the therapist on resilience. Push active, not passive coping. Maybe our success in improving functioning is only 15%, but for those it is worthwhile.

At the same time, I don’t want to “punish” those with low resilience: The 27 year old with dark glasses, talking in a whisper, asking for more opioids, with mom dutifully in tow, well we naturally frown on them but….. they are a product of their genes/environment/bad luck brain chemistry-wise.

You could study resilience all year and not know 20%.     Larry Robbins, M.D.

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