Standing at a podium in a Philadelphia hotel, Amanda Lindhout—a poised, elegant woman in her early 30s—told a harrowing story.
She survived a violent childhood and adolescence in Canada with an alcoholic and abusive stepfather, relying on her own grit and imagination to get through. After high school, she worked as a cocktail waitress and pored wistfully over exotic photos in National Geographic magazines. She eventually tucked away enough money to travel and become a freelance foreign correspondent.
Then in 2008, she was kidnapped while reporting in Somalia and held captive for more than a year, subjected to torture, hunger, and rape.
“I had lost everything,” she told the rapt room. “I had lost even the things you thought couldn’t be taken away from you. My own name. The sky over my head. Laughter. Light. And I never knew if I could make it through the day. So I would break it down and ask myself, ‘Can I get through the next minute?’ ”
She was eventually released after family members scrounged their every resource to raise the ransom her captors demanded.
When something happens to you that extreme, you could begin to fray at the edges, descending into depression, perhaps substance abuse, or post-traumatic stress. Or you could emerge relatively intact, like Lindhout seems to have done, able to speak articulately in front of hundreds of academics and journalists at the 2013 conference of the International Society for Traumatic Stress Studies, which had invited her as keynote speaker. The theme that year was “Resilience.”
“No matter how many times in captivity I suffered abuse, it never got easier, but to survive in there, I had to learn how to crawl out of this dark space in my own mind,” she said. “I began to nurture something inside myself, a tiny seed of compassion inside of me.”
Lindhout’s case is not scientifically unique. There are hundreds, thousands, probably hundreds of thousands of people around the world who have gone through their own version of hell—some of them resilient, some not. But in this room of psychologists and neuroscientists, Lindhout was a warm-blooded reminder why the work they do matters.
Resilience as a branch of trauma studies has grown rapidly in the last few decades, as no shortage of mass traumas, from genocides to war to mass shootings, have raised questions about the psychological fortitude of individuals and populations. That’s in addition to the quieter trauma—domestic abuse, illness, sexual violence—that happens outside the public’s view.
Researchers around the world are now collecting blood and saliva samples, brain images, and longitudinal data to help understand why some people cope well with adversity while others fall apart. Studies on resilience seem to come out practically every week. Among the research papers in the last few months alone: Columbia University found a genetic marker that indicates who’s more prone to PTSD; the Rotman Research Institute in Canada linked an individual’s memory skills to how well they recover from trauma; and a University of Chicago survey of entire neighborhoods after Superstorm Sandy determined that “social supports” were the most cited reason that 70% of storm victims were considered to be resilient.
Refining ‘Resilience’
The term “resilience” has become so commonplace that a strict definition is hard to come by. To some, resilience can mean the ability to bounce back after an intensely adverse event. It can mean being able to function better than expected after a traumatic experience, or a brief period of grief followed by a quick return to baseline functionality. Ann Masten—an oft-quoted resilience expert at the University of Minnesota’s Institute of Child Development—considers resilience more of a process than a state of being, one that’s highly dependent on the systems around you working well.
Amanda Lindhout considers herself resilient, but she does not claim to have emerged from her trauma unscathed. Afterward, she continued to have nightmares, and she’d tremble every time an unknown man sat next to her on an airplane. But by the time she appeared at the podium in Philadelphia, she’d co-written a book about her ordeal, offering a free copy to everyone in the room. “I think every time I can use my voice to own my story and what happened to me, it’s empowering,” she told me at the conference. “But that’s not to say that it’s always easy.”
“You’ve got to consider resilience in relation to your experiences and not an absolute,” says Sir Michael Rutter, a psychologist at the Institute of Psychiatry in London and an early pioneer in resilience research. Rutter oversaw the Isle of Wight study in the 1960s, in which he followed 2,000 boys over time and determined how well they did and under what circumstances.
“Resilience is not necessarily doing wonderfully. That’s competence,” he says “Resilience is doing better in relation to bad experiences than other people with similar bad experiences.”
When Rutter started his research, resilience was judged primarily on behaviors and circumstances that could be seen. The MRI machine had not yet been invented, and neuroscience had not yet exploded onto the scene. Since then, researchers have taken advantage of high-tech biological tools to help determine who is more—or less—likely to come through trauma without long-term psychology injury.
“We all know people, you look at what’s happened in their lives, you think, how are you so positive? How are you so resilient?” says Dr. Rebecca Elliot, a psychologist at the University of Manchester who studies the biology of resilient people. “Is there something we can identify in their cognitive performance, in their brain function, that marks those individuals out?”
At Elliot’s lab in England, she leads me into a windowless room with a computer and shows me a series of faces with ambiguous expressions—one of the exercises she gives her subjects. She tells me to click on the emotion that most closely matched the expression I was shown. I could choose from seven: angry, disgusted, scared, happy, sad, surprised, or neutral.
“The idea is, someone who is depressed is biased towards picking up negative emotion, and against positive emotion,” Elliot says. “We expect to see the opposite in people who are resilient.”
As I work my way through the exercise, I tend to pick “surprised” more than any other expression. Elliot isn’t sure what to make of that, she admits, but then again, this was only a demonstration.
So far, Elliot has recruited more than 200 people to take part in her study, some of whom have reported surviving extreme stress or trauma, and some who didn’t. She assigns each person to a group that seems to fit somewhere along the spectrum of resilience.
“Most people have a tipping point,” Elliot says. “And everybody’s tipping point is different. There are some people who can fall into depression with relatively little in the way of obvious provoking factors, and there are some people who need quite a strong trigger but will then develop depression.”
And there’s another type, she adds, who can withstand tremendous adversity and show almost no depression. “They have life histories that will make your hair curl,” Elliot says. “I’ve certainly interviewed people and thought, you know, if all that had happened to me, I think I’d be depressed. And yet they’re not.”
Elliot’s subjects gave blood and saliva samples and went through brain imaging. That helped the researchers determine who had the highest and lowest levels of the stress hormone cortisol, who had a genetic make-up that might suggest resistance to depression, or who had an active pre-frontal cortex thought to be important for executive function. Then they combined the biological data with a series of cognitive and emotional tests. For instance, the subjects were asked to re-arrange digital balls on a screen, to match disparate images together, and to solve complex anagrams, including some that were expressly designed to be unsolvable.
“It’s a bunch of tests … looking at planning and flexibility functions that we think might be important [to resilience] and also to get at emotions and emotional biases we think might be important,” Elliot says, adding that the most frustrating cognitive tests may be the most telling. “It may be that what makes someone resilient is not what you’re doing in a quiet, calm situation but what happens when something stressful comes along.”
Beneficial Hardship
On Amanda Lindhout’s worst days in captivity, she found a way to travel in her mind to other countries, to beloved childhood places, to the National Geographic magazines that she used to pore over. And as she was moved among different houses by her jailers, she also imagined a house in the sky looking down on her, separate from the nightmare of her daily life. (It would end up inspiring the title of her book, The House in the Sky.)
“When it was the very toughest, I could still close my eyes and imagine the life that I had lived and imagine the life that I wanted to go on to have,” she said, “utilizing the power and strength of the mind, which I had had to hone as a child.”
There is considerable research showing that childhood adversity puts one at greater risk for mental health problems—less able to cope with later trauma. Longitudinal studies, such as the CDC/Kaiser Permanente funded “Adverse Childhood Experience” study of the 1990s, have provided population-wide evidence for this theory. Neuroscience has attempted to explain why.
One theory—put forth by Dr. Bruce McEwen at Rockefeller University in New York—refers to “allostatic load,” or the level of stress that puts the body off balance physiologically. McEwen suggests that living in great stress or fear while the brain is still developing leads to an overproduction of the stress hormones like cortisol and adrenaline, and that in turn can overwhelm the stress response system and promote later disease.
Another school of thought suggests some hardship may, in fact, shore up resilience later in life. Michael Rutter thinks about this theory in terms of infection, where early exposure to a germ can inoculate you later on. “There have been people who have seen it as the goal of removing from children all stresses, challenges, and adversity,” Rutter says. “And I think that’s a totally wrong headed notion.”
That could explain why Amanda Lindhout thinks her early childhood may, in a strange way, have helped prepare her to survive her kidnapping. “I would say that growing up in a violent household like I did—a very poor household—where I was very often afraid for my own skin, my own wellbeing, my very body,” Lindhout said. “I just had to learn how to survive. I had to learn how to escape in my own mind.”
Yet that doesn’t answer the question of what makes someone like Lindhout able to reach into an internal toolbox—as a child or an adult—and pull out a trauma escape hatch, a strategy for resilience, while many others cannot. When asked, Lindhout thought for a moment and said, “I’m not sure I have the answer to that.”
Biological Basis
Even as more and more brain studies look at how an individual’s constitution affects his or her response to trauma and treatment, few researchers believe biology is a determinate on its own.
Dr. Stephen Suomi has dedicated his research to the interaction between genes and environment using rhesus monkeys as a case study. On a sprawling Maryland campus of the National Institute for Child and Maternal Health, he walked me around a variety of indoor cages and outdoor fields where adorable monkeys, most hanging on each other, seem to be in different states of agitation. “They’re about to get fed right now, which is why everyone is making so much noise,” Suomi says.
Suomi’s research team divides up rhesus monkeys in ways that can parse out genetic and environmental factors. Some monkeys have been raised by their mothers, while others are raised in a nursery by peers. The nursery environment is considered the tougher one to thrive in. The monkeys are also tested for a particular form of the 5TTT gene, which is connected to re-uptake of serotonin, a chemical linked to pleasure. “If you take the less efficient form of the gene and pair it up with adverse circumstances, you’ve got problems,” Suomi says. “But if you pair it with a good environment, it’s a different story.”
In other words, Suomi sees a genetic predisposition for resilience, but one that only develops in a nurturing environment. That same genetic predisposition may make someone—monkey or human—more likely to founder if brought up in a stressful, unsupportive environment.
As we enter a large playpen-type cage, Suomi points out that some monkeys have jumped up on an artificial branch in the cage, and they’re looking at me curiously. They’re the monkeys who were raised by their mothers and seem to be comfortable with strangers. They are deemed the resilient ones.
“And then there are the monkeys who were peer-reared,” he says, pointing to a tunnel that led into an indoor cage, where the monkeys who were taken away from their mothers live. “You’re not seeing any of them because they’re all inside, because they’re afraid.”
But the good news, he says, is that circumstances and, to some extent, gene expression can be changed. Suomi has recently become fascinated by the field of biology called “epigenetics,” which looks at how genes are turned off and on as a result of experience and environment. If childhood adversity can lead to maladaptive epigenetic changes, Suomi says, then social supports may reverse the damage. To test this notion, Suomi and his researchers have introduced into the cage what he calls “foster grandparents” in the form of an older monkey couple who offer extra cuddling or break up fights.
“That’s the kind of manipulation that we’ve found changes genes or normalizes gene expression,” Suomi says. “We’re making social groups smaller and less intimidating, and it looks like it’s normalizing the behavior of those who grew up in the nursery.”
Extending this principle to humans, Suomi points out the calming effects of yoga, meditation, and mindfulness training on many trauma survivors. In fact, those were the only methods of treatment that Amanda Lindhout said she found helpful. After her release, she said, she went through 20 different therapists who gave her no relief until she stumbled upon a mindfulness program that included talking to herself with soothing and encouraging words.
“I continue to be afraid of the dark. I have nightmares sometimes that jar me awake, and in confined spaces, like an elevator, I’m terrified. I sometimes feel like I can’t breathe,” Lindhout said. “But for my own good, I strive towards feeling forgiveness and compassion above all the other things that still rise up in me every single day.”
An Adapted Majority
While Amanda Lindhout’s horrific experience in Somalia may have been unusual, it’s possible her ability to emerge from it is not. Dr. George Bonanno at Columbia University’s Teachers College thinks most people are actually quite resilient. Over a number of studies, 65% of his subjects continued to function well after a traumatic event, even if they were at first extremely upset or bereaved. And that’s why he argues that resilience should be recast not as a clinical anomaly, but as a natural state of being.
“When we first discovered people were resilient after these events, we began to wonder, is it real?” Bonanno says, reflecting on the common belief that PTSD is widespread among trauma victims. But then he realized that most people who’d previously been studied for their resilience had been recruited through treatment programs. They were selected expressly because they sought help, thereby skewing the results. “The original ideas of how people cope with these events came from therapy,” he says.
After following survivors of natural disasters, wars, accidents, and other traumas over ten years or more, Bonanno discovered several common trajectories of resilience. Some seemed to do fine at every step, others had a dip into grief and then rebounded, and others took their time but eventually adapted well. Only 10%, he says, really couldn’t cope. But while these statistics could be construed as good news, Bonanno says he’s encountered much skepticism and even downright hostility.
“I’ve gotten a lot of pushback from the trauma world,” Bonanno says. “People have told me, point blank, if you keep talking about resilience, we’re not going to get money to treat people who are traumatized.”
Bonnano doesn’t deny that some people are not resilient, and if they make up even a small percentage of the population, he says, they still need help. But he contends that studying the majority who do cope well—borrowing from their adaptive traits—can help those who don’t.
“There’s something inherent in us that makes us resilient,” he says. “We have this marvelous stress response system. We have this incredible equipment that’s similar to what animals have. It’s versatile, it’s flexible, it allows us to cope with a lot of really bad things.”
Bonanno is wary of any therapist who claims to package their methods as a “resilience-builder,” a claim he considers “just clever marketing.” The truth is likely much more subtle, he says. A collection of small factors—from social supports to intelligence to optimism—add up to a resilient outcome. Some of those traits can be learned, developed, or gained over time, and some cannot. Sadly, he points out, the factors that are likely to build resilience over large groups—such as economic resources and education—are also the most expensive and difficult to change.
In the meantime, Bonanno says, most people—whatever their biology or environment—figure out a way to handle life’s challenges. And sometimes that way is messy, which is why he coined the phrase “coping ugly.”
“Maybe you need to scream at someone or maybe you need to get drunk or maybe you need to just hide away or maybe you need to do an impulsive thing,” Bonanno says. “But if it helps you cope, and ultimately it’s harmless, who cares if it’s less than pretty at the time? It got you through the event.”
Finding Meaning
Today Amanda Lindhout speaks frequently on women’s rights, on compassion, and on forgiveness. Inspired by a woman who once tried to help her escape, Lindhout founded an international aid organization, the Global Enrichment Foundation, which helps women in Somalia.
“Making meaning of what had happened to me has always been really important,” Lindhout said.
In that spirit, she ended her presentation with a quote from Holocaust survivor and writer Viktor Frankl, whom she has been reading from the time she was a small girl: “We must never forget that we may also find meaning in life, even when confronted with a hopeless situation, when facing a fate that cannot be changed. For what then matters is to transform a personal tragedy into a triumph. To turn predicament into a human achievement. When we are no longer able to change a situation, that is when we are challenged to change ourselves.”