Whatever Doesn't Kill You, Will Only Make You Stronger?

A few months ago, my father-in-law turned 80. As a gerontologist, I’m a big fan of celebrating major milestones when it comes to aging. But, for my father-in-law, I find this accomplishment more exceptional than usual. You see, we’ve suspected my father-in-law was a cat for years because he seems to have nine lives! Despite a barrage of serious health setbacks, and there have been some biggies, he always seems to bounce back.

We often ponder the reason for his amazing resilience, despite all odds. Is it something about his genetics (which would bode well for me given that I’m married to someone with half of his genes)? Possibly, though research suggests that genetics explains less than one-third of health outcomes in later life, so that’s definitely not the whole story (1,2). Perhaps it could be something about his lifestyle? Given his fondness of McDonald’s, Reese’s Peanut Butter Cups, Johnny Walker, and five decades of heavy smoking, I’d say that his health behaviors were unlikely beneficial to how well he’s fared. So that leaves us with psychosocial factors.

In a paper I recently published with colleagues (3), we examined how their level of psychological resilience influenced people faced with a major health event. Specifically, we created an index of self-reported resilience factors (e.g., how much they agree with the statement “When I really want to do something, I usually find a way to succeed at it.”) and examined how they influenced the extent to which getting a new chronic condition led to increased disability two years later. For example, if someone suddenly had a heart attack, we were interested in seeing whether he lost his ability to do things like bathe, go grocery shopping, or manage his money. Our study showed that the least resilient individuals were likely to experience a new disability, and those who were the most resilient recovered in less than two years such that they had no more disabilities than those who hadn’t experienced a major health event.

So, what causes someone to be resilient? There are several hypotheses.

1. Some people are innately more resilient and, therefore, are able to withstand more adversity than others.
2. Resiliency is a measure of social class—it’s related to whether or not people are born into a family that offers opportunities that allow them to do well in life.
3. People learn from bad things happening and develop tools to handle additional challenges later on.

For the first hypothesis, we have no reason to believe that resilience is a trait that you have or you don’t. Rather, like other individual characteristics, we may have a propensity towards certain personality traits at birth, but this propensity is activated by our environment, by our development, and by the people in our lives to collectively shape our psychological responses over time. This is not to say that we are unable to change our responses to our environment, but there is significant evidence to debunk the idea that resilience is something that we’re either born with or we’re not.

So let’s consider the second hypothesis, that resiliency is simply a measure of social class. If you are brought up in a family in which there are expectations and opportunities to experience success, and you observe success in others, you are likely to feel as though working hard will pay off. Furthermore, success (regardless of how you might define it) is more likely to be an expectation. On the other hand, if you grow up in a family in which your parents (or parent) spend many years struggling to find a job, pay the bills, and provide for your basic needs, you likely have fewer examples of how working hard allows you to overcome major challenges, and you probably have a narrower set of choices from which to make decisions that lead to success.

There is no doubt that social class plays a critical role in resilience. But, social class alone isn’t the whole story. We all have examples of these unique people who thrive despite all odds, and similarly, those who fail despite all odds. Is it possible that by having bad things happen and overcoming them, we learn how to have a better life? The answer seems to be…maybe, but it depends.

Recent research has emphasized the long-standing impact of early life traumas on health outcomes in adulthood. The more traumatic experiences an individual has during childhood, the worse his or her physical and psychological health fares several decades later (4). Part of this is likely related to social class, too. Those most likely to experience significant early life trauma are apt to be brought up in households with greater financial strain, less parental education, and in neighborhoods with greater crime and instability. But regardless of the factors that cause these early traumas, it seems that such significant events can dramatically alter our self-concept, our expectations, our early-life stress levels, and other factors that set in motion a series of problems. But what happens when difficult experiences happen after childhood?

My father-in-law did not face significant trauma early in life, but seems to have spent years sporting his resiliency in adulthood. After his early military service derailed him from his college trajectory early in adulthood, he managed to return to civilian life and complete his architecture degree while raising a young family—barely getting any sleep along the way. As a self-employed architect, he had a career that came with major ebbs and flows, which meant working excessive hours and experiencing a lot of stress. After about two and half decades of marriage and two sons (and I can tell you, they couldn’t have been easy kids to raise!), his wife had a brain aneurysm and subsequent brain surgery, followed by a diagnosis of lung cancer and two years of chemotherapy. He was left with a pile of medical bills and widowhood in his late 50s. He remarried, only to face a similar scenario a decade later.

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At age 72 and widowed twice, he remarried once again. When his current wife strongly encouraged him to stop smoking, to eat a healthier diet, and start exercising, he obliged. I am certain those changes have had a remarkable impact on his continued survival. And today, I’d say he’s happier than I’ve ever seen him. But, what allows my father-in-law to manage his current health challenges, make hard changes in his life, and get us to laugh hysterically when he shares his version of stories behind these and many other life circumstances, rather than complain, give in, and resign himself to the health problems plaguing him now? Some would say that he is simply more resilient than the average guy, his doctors included.

When bad stuff happens to resilient people, it appears that in the short-term they don’t do anything different from what nonresilient people do. Instead they feel something different about their ability to handle things. And as a result, they fare better physically and psychologically over the long-term. But as a colleague of mine pointed out, complaining about all of this fuss about resilience, “If something bad happens, what choice do you really have? You have to keep going.” And have you heard that manta: “Whatever doesn’t kill you will make you stronger”? Yet, people who have terrible things happen to them don’t always respond with such a mentality—some complain about the hand they were dealt. Others throw in the towel and stop trying so hard to get back up again. What do you do?

Over the last few years, as my father-in-law has experienced several health events that, alongside his existing chronic conditions, he’s had no reason to recover from, he’s left even his doctors bewildered. And, when we sat in a room full of his friends and family, toasting his 80th birthday, I wondered, how does he do it? Not only did he seem to be well recovered from his most recent medical set-back, which had occurred only a few weeks earlier, but he took us to the golf course to hit some balls. And he proudly showed us a picture of himself wearing a huge grin and holding an iguana from his recent trip to Mexico.

We don’t always have control over the health events or all of the situations we are faced with in our lives. But we usually have choices about how we respond to many of the challenges we face. And, it seems that how we respond really matters when it comes to our health. The next time you find yourself in a tough situation, try to take a step back and think about your emotional response to the situation and how you frame the problem in the context of your life story. Remember, resilience is learned and cultivated through life experiences, and learning, particularly about ourselves, is a lifelong process.

1. “Environment, not genes, plays starring role in human immune variation, study finds.” https://med.stanford.edu/news/all-news/2015/01/environment-not-genes-pl…
2. Crimmins, E., & Fitch, C. (2012). The Genetics of Age-Related Health Outcomes. Journals of Gerontology, Medical Sciences, 67A (5); 467-469.
3. Manning, L.K., Carr, D.C., & Kail, B. L. (2014). Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life? The Gerontologist.
4. Adverse Childhood Experiences Study. http://www.cdc.gov/violenceprevention/acestudy/