You will write about 3 to 4 main findings from the article assigned that week. In addition, you will need to develop a discussion question about the article.

RESILIENCE IN HEALTH AND ILLNESS

Romana Babie?, Mario Babie, Pejana Rastovie'*, Marina Curlin', Josip Simic',

Kaja Mandic' & Katica Pavlovic

SUMMARY

Resilience is a relatively new concept that lacks clarity although it is increasingly used in everyday conversation and across various disciplines. The term was first introduced into psychology and psychiatry from technical sciences and afterwards thorough medicine and healthcare. It represents a complex set of various protective and salutogenic factors and process important for understanding health and illness, and treatment and healing processes. It is defined as a protective factor that makes an individual more resilient to adverse events that lead to positive developmental outcomes. Resilience is a positive adaptation after stressful situations and it represents mechanisms of coping and rising above difficult experiences, i.e., the capacity of a person to successfully adapt to change, resist the negative impact of stressors and avoid occurrence of significant dysfunctions. It represents the ability to return to the previous, so-called "normal" or healthy condition after trauma, accident, tragedy, or illness. In other words, resilience refers to the ability to cope with difficult, stressful and traumatic situations while maintaining or restoring normal functioning. The higher the resilience, the lower the vulnerability and risk of illness. Resilient individuals tend to be optimistic, have a tendency to see everything as a useful experience, focus on personal strengths and qualities, use constructive criticism, develop close relationships with others, have developed social skills, and are emotionally conscious. Good resilience aggravates and prevents the onset of disease, provides good heath, facilitates and accelerates healing, and provides productive life and a sense of well-being despite chronic illness. Resilience experts believe that anyone can strengthen their resilience and thus contribute to the advancement of health and, if ill, ease the illness, accelerate and facilitate healing.

Key words: resilience - health - illness

INTRODUCTION

Resilience represents a relatively new concept which is still insufficiently clear despite its increasing utilization in everyday speech and various professions. The term was taken from technical sciences and introduced into psychology and psychiatry. In materials science, resilience is related to the capability of material to revert to its original form after being bent or pressed (the strength or capability of reverting to original form or position after bending, compression or stretching). Many researchers agree that resilience is a very complex phenomenon which is shifting through time and circumstances, and which can not be regarded as a one-dimensional con-struct. In psychology, resilience is generally defined as capability of an individual to overcome stress and un-happiness, and to recover. Psychologists dealing with personality psychology usually studied resilience as an individual attribute or characteristic (Thomassen 2018).

The founder of the theory of resilience is a clinical psychologist from the USA, Norman Garmezy, and after optimism, acceptance, focus on problem solving, defense mechanisms, forgiveness, responsibility, acquaintance and planning future. Resilient persons tend to be opti-mistic, tend to view everything what is happening to them from the perspective of useful experience, focus on personal advantages and qualities, use constructive criticism, develop close relationships with others, have developed social skills and are aware of their emotions.

The term resilience is very often used in psychologic literature by researchers to describe three different kinds of phenomenon: 1. Positive result despite risk status, ie. existence of risk of negative or poor result; 2. Continuous positive status and functioning despite unfavourable cir-cumstances, that is confrontation or maintaining competent functioning" in the presence of chronic or major acute life stressors (ie. divorce and similar). Resilience in un-favourable situations implies efficient confrontation which includes efforts to rebuild or maintain internal or external balance under a significant threat through means of human activities such as thoughts and actions; 3. Recovery after trauma, ie. adverse and/or damaging experiences and influences. This third concept of resilience is defined as successful adaptation despite unhappiness" (Jaksi et al. 2012, Masten et al. 1991). The aim of this paper is to clarify the role of resilience in health and illness.

DEFINITION

Resilience is not easy to define and there is no simple definition since the term covers a very wide range of features, is comprehensive and significant.

The name comes from the english word resilience" which was adopted in Croatian language. The word is translated in many ways, but most often means the ability to recover". It consists of personal qualities which enable the individual to thrive in the encounter of a problem (Garmezy 1991). Resilience is a compli-cated interaction of risk factors and protective factors which leads to positive development results (Thomassen

2018). It is a positive adaptation after stressful situa-tions and represents confrontation and heaving above hard experiences, that is, represents the capacity of a person to successfully adapt to changes, to resist the negative influence of stressors and avoid the appea-rance of significant dysfunctions (war trauma, family issues, workplace issues and similar). This does not mean that there is no awareness of the problem, absence of pain, not putting any effort to avoid the aforementioned.

Resilience actually represents the strength to handle and deal with a problem, and to continue normally through life (Zvizdic 2015). Resi-lience is a constant process of adjustment to newly created conditions which consists of acquiring a gro-wing and broader competence for stress reaction. It is in significant connection with the general develop-mental processes, relationships with significant others and the specific life circumstances of a person. Resi-lience development is closely linked to personality development as a whole, and is deeply individual as personality development (Deborah 2001).

In the context of comorbidity, it is important to bear in mind that there are different forms of resilience and that, in accordance with the cascade model, certain factors of resilience may contribute to development of others. It is useful to have in mind personal and group resilience (Fletcher 2013, Jakovljevi 2015), physio-logical, psychological, social and spiritual resilience (Jakovljevic 2019), and primary, secondary and tertiary resilience (Hicks 2011). Psychological and spiritual resilience actually represent psychological and spiri-tual defense mechanisms in crisis states, stress states

and trauma.

Psychological and spiritual resilience

include hope, activity, purpose and meaning, commu-

Curing mental disorders is associated with acqui-sition of life wisdom, development of positive thinking optimism, encouragement of love and gratitude, focu-sing on future, investing in life and its real meaning.

Tertiary resilience represents the ability of some person to live happily, creatively and productively despite the presence of one or more chronic illnesses, that is, a person actively and positively adapts to objective restric-tions in older age. From the aforementioned, primary resilience enables good health, physical, psychological, social and spiritual welfare, secondary resilience enables healing and personal recovery, and tertiary resilience enables quality life and a sense of wellbeing despite chronic disease. Appropriate resilience is a prerequisite for successful aging. Every human is a unique and responsible person who strives for self-realization, self-understanding and self-transcendence, its own integrity, self-control and management of its own life. The good news is that resilience can be increased and maintained by learning and training (Jakovljevi 2019).

RESILIENCE AND NEUROPSYCHOLOGICAL RESEARCH

Neuropsychological research point to the connection of certain temper and character dimensions, that is, per-sonality traits with the level of dopaminergic (DA), sero-tonine (5-HT), noradrenaline (NA), but other neurotrans-mitter activities. DA system is much more active in extroverted persons compared to introverted persons, where positive emotions are connected to additional links of DA in mesolimbic, and possibly in nigrostriatal DA system. The tendency to seek experiences and exploration of something new is also linked to increased DA activity.

The tendency to seek something new is linked to inter-action of genes DRD4, COMT and 5-HTTLPR, while the dimension of perseverance is linked to interaction of genes DRD4, DRD3 and 5-HT2C (Jakovljevi 2018).

Connecting comorbidites and multimorbidities on a neurobiological, neuropsychological and patophysiolo-gical level could significantly contribute to their more successful prevention and treatment. Optimism as a personality trait plays a very important role in resi-lience, and is asociated with activity of neural circuits of the reward system. Positive emotions, capacity for self-regulation, social competence, social support, close connections to helpers, lower level of denial, avoiding behaviour and retreat, greater flexibility of thinking and open-mindedness, dispositional optimism, are very im-

stress. Resilience is associated with fast activation and efficient completion of stress response. Dehydroepiandro-

role in well-being feeling (Jakovljevi 2019).

RESILIENCE AND HEALTH

Resilience represents a complex set of various protective and salutogenic factors and processes which are very important for understanding health and illness, process of treatment and healing, including comor-bidities and multimorbidities.

The focus here are

biologic, psychological, social and spiritual factors and mechanisms which, in every life age, modulate the relation between stress, trauma and/or illness on one side and positive, favourable or desired result on the other side (Jakovljevi 2019, Masten 2012, Maddi

2005). Resilience represents the ability to go back to the previous, so-called. normal or healthy condition, after some trauma, accident, tragedy or illness. In other words, resilience denotes the ability to cope with hard, stressful and traumatic situations while maintaining or restoring normal functioning.

The higher the resi-

lience, the lower the vulnerability which makes risks of disease and multimorbid conditions lower. According to some, resilience is associated with a force which drives a person to grow through suffering, stress, trau-ma, disorder or disease. Posttraumatic growth and resilience are two associated, but still different terms.

Mental disorders often have the function to encourage the patient to transform his wrong beliefs, to give up his wrong goals and life values and find new and authentic values, to revise his loser story and reveal his authentic life mission through different roles thus shaping his new identity.

Symptoms and neuropsychobiological disfunctions often overlap in mental disorders and many mental and somatic disorders are comorbid, which significantly affects the result of treatment. Beside researching dis-order-specific mechanisms, it is of great importance to identify disability-specific mechanisms of abilityto recover. Transdiagnostic research of general and specific ability of recovery could significantly contribute to strengthening the concept of holistic-oriented medi-cine. Creating a more resilient brain in cancer patients is a huge challenge for the modern basic and clinical sciences (Masten 2012, Jakovljevi 2012).

RESILIENCE AND STRESS

A generally known fact is that some people are more sensitive or hypersensitive to unfavourable life events, that is, vulnerable to distress, while other people are more resistant and adaptable. Diathesis, as vulnerability, cognitive features, and emotional and interpersonal resilient people can handle, for most people, difficult psychosomatic stresses, without any damage to mental and somatic health. It should be remembered that even the most resilient personalities can decompensate and develop a mental disorder when distress exceeds their endurance limits and overcomes adaptive capacities.