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concept through various instruments of measurement that nullified by PTSD symptom incidence in SOF, which is nearly
ostensibly quantify resilience. 41,59 High resilience purportedly double the rate estimated for conventional forces. Scarcity of
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palliates adverse mental health outcomes 44,64 ; the more resil- resilience research in the SOF community indicates poor prog-
ient one is, the less depression or posttraumatic stress (PTS) ress in understanding the experiences of SOF and their fami-
they should presumably exhibit, according to prevailing con- lies. Findings from this conceptual analysis clarify the concept
clusions. 40,42,44 Low resilience is associated with increases in and provide critical discovery of assumptions lacking evidence
high-risk behaviors and mental health symptom prevalence. to support them.
19
Despite claims that resilience is associated with improved
mental health, there is limited evidence that concretely mea- Critical Findings: Redefinition and Conclusion
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sures those consequences beyond self-reported surveys. Post- The most critical finding of this conceptual analysis is that, at
traumatic stress disorder (PTSD) has four main domains in best, resilience is redefined as an ability to withstand adver-
its archetypical model: intrusions, avoidance, hyperarousal, sity. At most, the definition covers individual use of protective
and dysphoria, 65,66 yet no attributes of resilience (e.g., control, resources to defend against an onslaught. As redefined, resil-
commitment, challenge) are precisely antithetical to PTSD di- ience is not imbued with imprimaturs of positivity; concep-
agnostic domains, despite conclusions that low resilience cor- tually, resilience is elementally disconnected from predictable
relates with higher PTSD symptom exhibition. 42 longitudinal outcomes. Even the most resilient—those who
can withstand the most hardship for the longest periods—have
Consequences of low resilience (hardiness) in Soldiers report- a breaking point.
edly result in poor leadership qualities and failure to be suc-
41
cessful within the SF Q course pipeline. Acquired resilience Findings from this conceptual analysis thus enable this hy-
26
is seemingly rooted in tenets of positive psychology: bravery, pothesis: For many in the SOF community, the presence of re-
intrepidity, strength. In contrast, PTSD and suicidality are em- silience—withstanding and surviving deployments, sustained
pirically and conceptually disconnected from the positive psy- violence, threats to life, deaths of beloved teammates, and
chology movement. Resilience remains a nebulous concept of constant separation from support networks—is empirically
66
multiple cognitive and behavioral elements, almost none of divorced from risks of negative sequelae (e.g., PTSD, suicide).
67
which concretely correlate with accepted clinical domains of Emerging evidence indicates neuropathologic consequences of
PTSD, though resilience-building programs such as Master blast biophysics, 71,72 explosions to which most in SOF have
66
Resilience Training, Battlemind, and so forth have abounded most certainly been repetitively exposed, can create neuro-
73
throughout the military. As such, researchers risk misinterpret- psychiatric symptom spectra 71-73 that no amount of acquired
ing consequences of individuals having low or high resilience or inborn resilience could possibly mitigate.
and may continue to conflate consequences of resilience with
the presence (or absence) of suicide risk, stress, or trauma The ability of SOF to “bounce back” from adversity to base-
symptoms. 24,25 line is immaterial when their baseline is, at its core, inherently
different from conventional forces’ baseline and consistently
Compounding this conundrum are assumptions that repeated higher in threat. As a contextual concept, resilience in SOF
deployments and sustained exposure to stressful situations requires separate exploration and study. Results of resilience
are inherently and invariably damaging. A post-deployment studies performed with conventional military participants
68
cross-sectional study of conventional US Army medics found have limited external validity for the SOF community and
years of service and deployment history correlated with higher thus should be generalized with explicit caveats of those limi-
resilience and reduced reporting of PTSD symptoms. Astutely, tations. Perpetuating narratives of SOF hyperresilience creates
64
investigators controlled for bias and found strong predictions severe consequences in the absence of empirical evidence.
of PTS symptom reporting in regard to hardiness; medics’ self-
reporting was skewed toward socially desirable responses of Acknowledgment
high resilience and low PTS. A 7-year longitudinal study of This article is dedicated to the memory of SO1 (SEAL) Ryan
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Soldiers demonstrated combat experience increased emotional Francis Larkin, Special Operations Combat Medic and Naval
stability, social support, and resilience; multiple deployments Special Warfare Sniper. We are listening.
were significantly associated with decreased neuroticism and
increased conscientiousness. Consequential covariates may Disclosures
69
also mediate or moderate connections between PTSD and re- The statements herein do not imply endorsement from any af-
silience, such as concomitant blast-related neuropathologies, filiated organization or entity associated with any author of
pharmacotherapeutic influences, and other nascent foci in this manuscript.
military neuropsychiatric research.
Author Contributions
Implications All authors approved the final version of the manuscript.
Resilience is consistently proffered as a salutogenic: a cure
mitigating negative mental health sequelae despite explicit References
statements in rigorous military resilience studies indicating 1. Saul J, Simon W. Building resilience in families, communities,
resilience remains poorly understood as a concept. 67,69 Resil- and organizations: a training program in global mental health
ience is championed as an inoculation to the rigors of war and and psychosocial support. Fam Process. 2016;55(4):689-699.
psychological sequelae resulting therefrom. Silent profession- 2. Cuervo I, Leopold L, Baron S. Promoting community pre-
paredness and resilience: a Latino immigrant community-
als from the SOF community are appropriated as a basis for driven project following Hurricane Sandy. Am J Public Health.
narratives of hyperresilience without a body of high-level evi- 2017;107(S2):S161-S164. doi:10.2105/AJPH.2017.304053
25
dence supporting that myth. If SOF are hyperresilient and re- 3. Rice V, Liu B. Personal resilience and coping, part II: identify-
silience parallels psychological immunity, both hypotheses are ing resilience and coping among U.S. military service members

58 | JSOM Volume 18, Edition 1/Spring 2018