Can one spring back from psychosis? The role of resilience in serious mental illness

The term resilience derives from the Latin verb resilire to leap or spring back. Fundamentally, all definitions of resilience comprise the core elements of adversity paired with a positive outcome. Historically, the empirical study of resilience has been impeded by the view of resilience adopted by the researchers involved leading to a fragmented and disjointed conceptual understanding of the phenomenon. Rutter (2006) views resilience as being an interactive concept where an interaction occurs between adverse experiences and positive adaptation. Therefore, differences in resilience could be a function of differences in exposure to aversive experiences and the resultant coping mechanisms adopted.

Rutter (2006) explores the concept of resilience in a bid to delineate whether resilience is truly a new concept or simply the notion of risk and protection repackaged under new terminology. It is delineated that resilience is distinct to both risk and protection, but prior knowledge of both risk and protective factors are essential to the study of resilience. That is two individuals could experience the same aversive event, have the same protective factors and have very different outcomes. Thus, individual difference factors are imperative in resilience.

Why is resilience important?

The phenomenon of resilience is important as it is tied to the notion of people overcoming aversive experiences and adapting positively after such experiences. This could encompass returning to an individual’s pre-aversive event baseline, prospering beyond their pre-aversive event baseline or forging an entire different path – fundamentally, some degree of a positive adaptation. Thus, in regard to serious mental illness with the experience and diagnosis of serious mental illness being the aversive event, the notion of resilience is fundamentally tied to the prognosis of the individual.

Thus, resilience could be the key to understanding why two individuals with a similar diagnosis of the same serious mental illness and similar protective factors have distinctively divergent outcomes and prognosis. Such an understanding will assist with informing interventions to promote resilience and hence increase positive prognoses in those with serious mental illness.

The study of resilience

The phenomenon of resilience has been studied for decades originally research focussed upon children who had been maltreated or lived in poverty; the focus at this time was upon protective factors (Mizuno et al., 2016). This constitutes what has been termed the first wave of resilience research by Richardson (2002), and it involved documenting lists of qualities and protective factors that assisted individuals with overcoming adversity.

Since this time research into resilience has expanded with the phenomenon being investigated in more diverse populations and contexts as well as research focussing upon the dynamic nature of the construct as opposed to static protective factors. Thus, researchers began studying resilience from a process-based perspective (Mizuno et al., 2016). That is, resilience is best conceptualised as an active concept.

The second wave of research focussed upon how to acquire the qualities and protective factors identified as promoting resilience in the first wave of research (Fletcher and Sarkar, 2013; Richardson, 2002). While the third wave of research investigated the motivational forces involved in resilience and how these ‘forces’ pushed individuals and groups towards self-actualization in the Maslowian sense.

Where to from here …

Although the concept of resilience and related research has evolved over time, numerous gaps remain especially in relation resilience and serious mental illness. First and most fundamentally, how resilience is conceived and measured. A commonly used criterion for a resilient outcome is mental health, that is, an individual is said to be resilient if they have suffered an aversive event without experiencing psychopathology after the event. This criterion is clearly not appropriate within the context of resilience in mental illness. Furthermore, it is demeaning as it implies that resilience is not possible within mental illness, which is not the case.

Alternatively, sometimes the constructs of quality of life and well-being are utilised as a pseudo-measure of resilience, however both of these constructs are distinct to resilience. Resilience is highly related to both quality of life and well-being. Resilience contributes to quality of life and well-being, but these constructs are not indicative of the ability to bounce back or resilire from aversive events. Thus, there is a need to understand how resilience is best conceptualised and measured within the context of serious mental illness?

Although there are scales specifically for measuring resilience, a recent review of research assessing resilience in schizophrenia concluded that there is no ‘gold standard’ measure for resilience in this population (Mizuno et al., 2016). Furthermore, another approach to assess resilience is the use of pre-determined objective indicators (such as employment) within the context of serious mental illness, such indicators may not be appropriate. Thus, how should resilience be operationalised in the context of serious mental illness?

In addition to the aforementioned issues, the notion of coping is also important as although the role of coping in resilience is not well understood; coping may be a source of resilience. Furthermore, it is plausible that at the minimum coping is a mediating mechanism between an aversive event and a resilient outcome. Equally plausible is that coping is a consequence of resilience. What is known is that coping is strongly tied to resilience, as individual differences and environmental factors alone are not adequate in explaining resilience (Rutter, 2007).

Attempting to answer the four key propositions stipulated above both in general and specifically in regard to serious mental illness will garner a better understanding of resilience and its possible applications within mental health. Furthermore, it remains unknown as to whether resilience is distinct in serious mental illness. It is possible that resilience is different in serious mental illness as resilience is highly contextualised. Such work will provide insight into interventions and the individualisations of interventions and treatment for this population as resilience is a stepping stone to recovery for this population.