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Resilience as victim-blaming

 •  • by Paul Ingraham

Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.


I feel like “resilience” has just become medicine’s way of victim-blaming people who burn out instead of actually enacting structural change.

This may not be what Dr. Copps meant, but the idea of resilience has probably been overused and abused in the world of musculoskeletal medicine. I think it’s just fine for many patients in the worried-well category: people who are mostly healthy, but struggling with a new painful problem, can often benefit from strong reassurance. It’s often needed as an antidote to their fear of fragility — a fear often flamed by healthcare professionals who don’t know any better, who like to blame painful problems on glitchy anatomy and biomechanics, rather than the messier reality. In that context, resilience is a valuable concept, as in: “Back pain does not mean your back is fragile and degenerated. In fact, spines are extremely strong and resilient… even with signs of arthritis.” That kind of reassurance can help a lot of people.

But that’s not everyone. For many others, maybe resilience talk is tone-deaf, preachy, ableist bullshit.

Many people have high vulnerability to overload for reasons way out of their control. Metabolic syndrome, maybe a genetic gift of chronic pathology, overwhelming stresses from poverty, social injustice, and so on. They glance at a tendon wrong and it bursts into flame. For these people, the idea of “resilience” probably sounds hollow and privileged.

And that’s just normal unhealthiness. Then there’s everyone with unexplained chronic illness/pain — and there are millions of us. Most days my own body feels about as “resilient” as a burning house of cards. And if a healthcare professional tried to convince me that I am more resilient than I think, my impulse would be to laugh. Or punch them.

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