Preface

Humans are remarkably resilient in the face of crises, traumas, disabilities, attachment losses, and ongoing adversities. In fact, resilience to stress and trauma may be the norm rather than the exception. However, to date, most research in the field of traumatic stress has focused on neurobiological, psychological, and social factors associated with trauma-related psychopathology and deficits in psychosocial functioning. While much has been learned in these areas of research, particularly about post-traumatic stress disorder (PTSD), far less is known about resilience to stress and healthy adaptation to stress and trauma.

The study of resilience is enormously challenging. The first hurdle involves definition. Currently, there is no single agreed-upon definition of resilience in the clinical or scientific literature. In a review of the published literature on risk, vulnerability, resistance, and resilience, Layne and colleagues (2007) described the lack of precision and numerous terminological inconsistencies in the meanings of these concepts, and identified at least eight distinct meanings for the term “resilience.” For example, definitions of resilience have ranged from symptom-free functioning following trauma exposure (Bonanno et al., 2006) to positive adaptation despite adversity (Garmezy, 1993), and even to enhanced psychobiological regulation of stress/fear-related brain circuitry, neurotransmitters, and hormones (Charney, 2004). The American Psychological Association (2010) has defined resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat.”

Introduction

Resilience in the face of adversity is vital for military service members to survive potential threats to their own lives and safety and to accomplish assigned missions, often for the sake of others’ survival and welfare. The ability of service members to bounce back from operational stress may also determine how successfully they reintegrate with their families and communities after returning from deployment, whether they can continue to work in military professions, and whether they develop potentially disabling mental disorders or other serious behavioral problems. Military organizations have long traditions of selecting, training, and sustaining service members to endure intense and persistent operational stress without losing their abilities to function on the battlefield, but other indices of resilience have only recently attracted the sustained interest of the military. As military organizations develop programs to promote a broader spectrum of desired stress outcomes, they are faced with a choice between expecting traditional resilience-building methods to meet untraditional objectives and creating entirely novel approaches to resilience.

Academic interest in the psychological, biological, social, and personality-trait differences associated with successful adaptation to combat and operational experiences has increased rapidly since the late 1990s. Underlying recent studies in this area has been the assumption that the incidence of various mental health and functional problems associated with combat and operational experiences might be reduced if modifiable risk and resilience factors could be identified and then targeted in military prevention programs. Unfortunately, research and translational programs to enhance resilience in members of the armed services have, so far, been limited by the lack of a unified or paradigmatic approach to conceptualizing the military and extra-military processes and functions that may lead to resilient outcomes, and even by the lack of a consensus definition of resilience. Uniform methods of measuring resilience processes or outcomes also do not yet exist. The little empirical research that has been conducted in the military has significant internal and external validity problems, greatly limiting their power to inform prevention or intervention practices, which is the basic goal of resilience research.

Ritchie and colleagues should be congratulated for their work at the Pantagon on and after September 11, 2001, for their useful and rich depiction of that horrific day, and its aftermath, and for the various mental health activities provided to victims, the traumatically bereaved, first responders, and graves registration personnel. In order to appreciate the demands placed on Ritchie and colleagues, any mental health professional need only to ask themselves what they would have done on 9/11, and what they are prepared to do if a mass violence event were to occur in their work setting or vicinity and they are called on to plan, implement, or assist in providing mental health services to victims, workers, and their families. There is no doubt that mental health professionals, public health officials, and individuals responsible for planning disaster mental health and terrorism responses in employee assistance programs and various work systems and organizations have much to gain by absorbing the information provided by Ritchie and colleagues.

The authors describe the enormous difficulties and exigencies of deriving a working, good-enough mental health response plan that would be amenable or tolerable to the military culture, and to the unique work culture at the Pentagon for civilians and families of employees and military personnel directly and indirectly exposed to the attack on 9/11. The decisions made about resources, the content and process of the interventions provided, and who and where they would provide them were arguably about as good as could be expected, given the state of knowledge in disaster mental health and the unprecedented nature of 9/11 terror.