Page 61 - JSOM Fall 2023

of negative thoughts for positive ones. The “bounce back” We defined unconventional resilience as “dynamic freedom
framework of conventional resilience is problematic because of maneuver which facilitates connection to self, others, and
of its (1) hyper-focus on individual cognitive performance; (2) world amidst ambiguity.” This was revealed by analyzing SOST
disconnection from the kinetic reality of operational medicine; practical performance and discovering an integrative, trans-
and (3) decontextualization of performance from the deploy- formational process that promotes change-agency through the
ment cycle. 3 force of movement. Advantages implied in this definition of
unconventional resilience are that it enables adaptive perfor-
The following quote illustrates the mismatch between SOST mance in adversity, capitalizes on diverse human experiences,
medics’ personal experience of catastrophic injury and ap- and develops a holistic relationship to hardship. Practical
proaches to conventional resilience: performance of unconventional resilience across the deploy-
ment-cycle occurs at three levels: organizational, team, and
Everyone talks about resilience but, having seen many individual. The latter levels of unconventional resilience are
mental health providers, it was frustrating. There were so discussed in detail in our next paper.
many who said: “Stop, count to ten, and think about a
bunny rabbit.” The lack of appreciation for these unique We provide an example to illustrate the advantages of uncon-
experiences was totally disheartening. From the first ventional resilience according to this definition. The following
day we started receiving casualties, the flood gates just quote expresses the alignment between SOST medics’ personal
opened and it was a steady flow 24 hours a day seven experience of catastrophic injury and our definition of uncon-
days a week. We quickly learned war isn’t pretty, clean, ventional resilience:
clinical, or easy. It’s gray and dirty, not black and white.
The wounds are so incredible that you can’t even imag- Our casualty collection point was an old family house with
ine them. Even if it’s not a battle injury, long-term injury two buildings. We built an ER on one side and an OR on
from disease runs rampant. Death and destruction are all the other. It didn’t have electricity. It was hot as hell, 105
around. When we get back, there is no time to process degrees during the day. We were less than a kilometer
and everyone expects us to go back to who we were be- from the fighting and could feel the concussions of the
fore deployment. So, resilience means being able to bury bombs when they hit. The flood gate of casualties just
everything because we immediately continue our military opened. They’d pull up in these trucks, with a bunch of
and clinical training schedules. The consequence is we all bodies in the back just covered in dirt. We would yank
carry around a graveyard of patients we’ve taken care of them out and set the dead to the side to get to the ones
who have died. Resilience has to be geared at optimiz- that were still alive. We did the best we could with the
ing who the Servicemember is now, not focused on some resources we brought, but obviously we ran out of every-
ideal past image of who the Servicemember was before thing. We built relationships with the locals so they would
they left for deployment. You can be a better person. You bring us food and medical supplies that they’d try to find.
can be a stronger person, but you are never going to go They really tried to make things happen for us. Still, it
back to being exactly the person you were before these was really hard. We didn’t even have exam gloves. We
incredible experiences. were using lunch lady gloves that the locals brought to
us. Problem is your finger goes through the lunch lady
The SOST medics’ visceral response highlights their dissatis- gloves; so, we were putting in chest tubes with our fingers
faction with the conventional resilience construct and reveals inside the person’s chest.
the “bounce back” framework’s failure to engage individuals
in a process that gives authentic value to catastrophic injury The SOST medics’ responses to the hardship of catastrophic
exposure; accurately assess the tactile, felt-sense and fluctuat- injury exposure illustrates freedom of maneuver to adapt to
ing nature of the operational environment; and consider day- personal, interpersonal, and contextual adversity. In this ex-
to-day stresses associated with family, military, and medical ample, freedom of maneuver was fostered through mutual
responsibilities that impact practical performance. Aligning collaboration with local nationals to overcome obstacles,
resilience with SOST medics’ practical performance requires enabling constrained resource breakthroughs. The SOST’s
integrative processes that utilize deployment experiences and, holistic relationship to hardship amidst dirty, bloody, chaos
in particular, catastrophic injury exposure as a catalyst for manifests in practical performance with medical agility that
transformation. embraces ambiguity as a transformative opportunity. Their
ability to synthesize diverse human experiences amidst hard-
Unconventional Resilience: ship enabled them to be change-agents and constantly adapt to
Definition and Advantages incredibly challenging conditions.
In response to the question, “What is resilience?” we present Unconventional Resilience: Components of
our new definition of unconventional resilience. One of our Strategic Framework with Conceptual Attributes
most consistent observations was the cultural importance of
achieving individual, team, and organizational freedom of We now describe the three interdependent components of
maneuver within SOF. Freedom of maneuver was a saturated unconventional resilience, which facilitate connection to self,
theme that consistently appeared in the language used by SOST others, and world: dynamism, freedom of maneuver, and am-
medics to describe their practical performance across the de- biguity. Using ethnographic data, our bottom-up approach
ployment cycle in individual interviews, focus groups, and articulates the internal meaning of each component and their
during field observations. It became the driving force of our attendant conceptual attributes. This unified framework pro-
1,2
analysis and shifted our focus away from the static elements vides a coherent strategy that more thoroughly answers the
of the “bounce back” framework of conventional resilience. question: “What is resilience?”

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