Bal Harbour

Harvard professor of Public Health Karestan C. Koenen shares a personal story of resilience—a practice that she believes can help us heal ourselves, as well as maintain good health. Resilience in Practice IN EARLY MARCH, MY FRIEND STEPHANIE received the news that her breast cancer had relapsed. While she was grappling with decisions about treatment, COVID-19 was declared a global pandemic. All of us scrambled as our workplaces and children's schools closed, public officials issued shelter-in-place orders and necessary supplies like toilet paper flew off store shelves. Stephanie faced a long road of chemotherapy, surgery and radiation while the pandemic robbed her of almost all the support and resources on which she would usually have relied. Stephanie and I graduated from Wellesley College in 1990. Our friendship cemented during our early 20s, when we both began our careers in New York City. We shared the experiences of living in a one-bedroom apartment with multiple roommates, raiding the complimentary refreshments at gallery openings and taking endless walks up and down the length of Manhattan. Stephanie was the last friend I called from the airport when I panicked before leaving for the Peace Corps in Niger, West Africa. She was the first friend I called when my father died. She had buried her father only two months before. Since March, Stephanie has been quarantined with her two cats in Chicago. While I—like everyone—have struggled with working from home, school and camp closures, separation from family—cancer compounded Stephanie's experience. Stephanie lives alone, and only recently was she cleared to meet friends outside. Her cancer is aggressive; she will be continuing with targeted therapy treatment until April of 2021. e treatment that aims to save her life puts her at risk of severe illness or even death from COVID-19. Stephanie and I recently caught up by phone. Our conversation leaped from topic to topic, as happens with friends of 30 years. She was scared; she faces at least nine more months of cancer treatment. Her mother lives in New Jersey, her brother in Brooklyn and her sister in upstate New York. She is worried she may never see them again. But she was also excited; the next week, she would officially be on vacation from work. Her doctor had cleared her for a day trip with her friend to visit Kemil Beach at the Indiana Dunes National Park. During that call, I asked her what kept her going during this time. I was struck by the parallels between her examples and those of Jane McGonigal—an author and game designer renowned for creating games that help treat real-life health challenges. McGonigal identifies four types of resilient behaviors: social, physical, mental and emotional. Social: Despite Stephanie's fierce independence, she sought help from others. She organized friends to drive her to and from chemotherapy, bring her meals and pick up groceries and medications. She updated her team at work about her medical condition and delegated work projects to them. She started a WhatsApp group called "Blue Butterfly" to update friends and family about her treatment and provide a forum for support. Physical: Despite fatigue and nausea from chemotherapy, Stephanie continues to work as much as possible, leading her museum's conservation department. Stephanie dons her mask and gloves to walk around her neighborhood. She has also learned to make time to rest during the day. For a driven, active person, learning to rest is a resilient behavior. Mental: Stephanie is an art conservator who has focused much of her career on preserving objects from underrepresented populations. For example, she worked in Haiti from 2010-12 to recover cultural heritage after the major earthquake. She is deprived of travel and visiting the museums and galleries that usually bring her so much joy. Instead, she is seeking stimulation in reading. Emotional: Stephanie consciously seeks opportunities to find joy in simple experiences. She describes the oasis she has on her small balcony that enables her to enjoy the "outdoors" without leaving home. McGonigal and others argue that resilient behavior will enable us to live longer. As a scientist, I am skeptical by nature, and my brain will always seek more data and better studies before being convinced. But, what I am sure of is this: when I called Stephanie, I intended to encourage her, but she inspired me. I hope Stephanie's resilient behaviors will lengthen her life—and mine. But even if they do not, practicing resilience will make our time on this earth better, and I will always be grateful to my dear friend for that. Are You Resilient? Why are some people more adaptable? Why can some cope better than others? The answer is resilience. There are eight characteristics commonly found in people who have an aptitude for resilience: • They are able to detect the cause of their problems. • They know how to handle their emotions. • They keep calm in stressful situations. • They are realistic. • They trust themselves. • They are empathetic. • They are able to motivate themselves. • They don't ask why, they ask how. Karestan C. Koenen is a professor at the Harvard T.H. Chan School of Public Health, where she leads the COVID-19 Mental Health Forum. She is a licensed clinical psychologist and epidemiologist whose work focuses on using science to overcome violence and trauma. 110 BAL HARBOUR

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