Listen: You’ve heard about resilience. Its being sold in all kinds of ways. Want to improve resilience? Have you tried cold showers? Have you tried intermittent fasting? Have you heard about Misogi? Have you tried push-ups at 4 a.m. and not sleeping? Resilience has been hijacked by quick fixes and hard tasks. All this has blurred our understanding by offering a wide range of often-contradictory processes.
As a firefighter and psychotherapist, I have a unique vantage point. On one hand, I see a service striving to attempt to ensure that the brothers and sisters that serve, and serve well, to their fullest extent and at the highest performance possible. As a firefighter, I see resilience as the ability to continue to do our job under immense stress. Ross Edgely, the extreme swimmer, put it better than most papers I’ve read: “Resilience is suffering strategically managed.” (1)
As a psychotherapist, I see the devastating and destructive nature of invisible wounds: the increase in drinking, the ostracizing of family and friends. In the volunteer fire department world, this took the form of pagers and radios dropped off at the chief’s office, gear growing webs in the locker room, put there by people who, upon arriving to someone’s bad day, in turn had themselves a bad day. In some cases, that day grew to a place where they couldn’t serve anymore. In some circles, we’ve judged that as not resilient.
Two Ships in the Night: Mindset vs. Resilience
My writing and research suggest that we’ve been having a dual conversation that is confusing the waters. I’ve written elsewhere about the difference of mindset work and resilience training. Let’s be clear—they are not the same thing. When you have non-clinicians attempting to support in the way that they know how, you get a complex Frankenstein of a program. Much of what I have seen that is meant to bolster firefighters’ resilience is much more appropriately regarded as mindset training. Can you look something difficult in the face—a 24-hour challenge, a solo trip, a Misogi—and complete it?
The sense of accomplishment you get at the end of such a trial is not nothing…but its also not saving people from the demons that may haunt them from the calls we go on.
How Effective Are Current Mental Health Efforts?
Look at the resilience that is designed by clinicians for firefighters. Much of it proves little better. Research here in Canada is telling: there were “no statistically significant changes in symptoms of depression, anxiety, stress, posttraumatic stress, and alcohol use, at any follow-up time point, following the training intervention,” says Nicholas Carleton, who was looking at all the various trainings offered. He and his colleagues reviewed one of the most popular “resilience” training programs offered across all first responder populations. Fact is, most of these programs don’t have some nerd like me attached to them to monitor and ask the hard question: Is this actually helping? When we do, as was done to the program mentioned above, we often get “no” as the answer. Worse, we’ve adopted the idea that having a token nerd, like me, come and bore your shifts to death during the winter season (when it’s not much fun to play outside) on awareness-level mental health information counts as mental health training. This criticism was a hard truth pill to swallow; I did this, and still do, to some degree, for departments that request it. Yet Jennifer Wild, who works at some obscure and little-known U.K. university called Oxford, had this to say: “We found no evidence of the effectiveness of pre-employment screening or psychoeducation offered as a standalone package, and little evidence for interventions aimed to improve wellbeing and resilience to stress”. (3)
I love to come to new halls and persuade them to give me a T-shirt with their insignia on it in exchange for the wisdom I’ve amassed over the years, but, at least now, it comes with the disclaimer that this is nothing more than an information-sharing session.
And this matters—or at least I think it should.
The Statistics on Firefighter Mental Health
In Canada, 85% of the fire service is paid on call; the U.S., it’s 65%, in additional to purely volunteer services (yes, they exist in Canada, but they are rare). Any dollar that isn’t going directly to gear and apparatus is a cherished dollar that needs desperately to go somewhere else. How can those stations, then, spend a few thousand on having someone come in with a resilience program, positing just the right witch’s brew of things that will ensure a “resilient” firefighter? There is no research to suggest any one program is as helpful as we hope it might be.
Resilience, then, is this slippery fish. Statistics on mental health rates suggest that the ranges vary to such a significant degree to be unhelpful. Somewhere between 9-30% of members are dealing with mental health issues; alternately, some research suggests as many as 50% are. If I’m a fire chief, I’m then trying to gather dollars to provide mental health support for either a small portion of my staff (9%) or half my staff (50%). This is not super helpful in making a business case for funding for mental health. I’ll wager that the ability to access funding through governmental support (though varying state to state, I would also guess) is not always helpful, not always smooth, and not always supportive. I make this supposition based on a single piece of evidence—it’s like that here in Canada.
This poses a different question that hasn’t been asked much but could likely tell us quite a bit. Somewhere between 50-91% of our brothers and sisters, then, don’t hit this rate. Somewhere between most of us and half of us—despite the calls, despite the scenes and the smells and the emotion—seem to be okay overall. We don’t often focus our attention on this, but there are meaningful things to learn. We would learn that coping styles are different for those people, that social structures and support and use of those supports were different for those people, or that they may had been fortunate enough to not have too many compounding bad calls on top of compounding personal stress. Perhaps their homelife didn’t significantly contribute to the cumulative stress of the work life. Perhaps they just see things differently or think about what they see differently.
To be clear, I don’t think this means “they’re resilient” and “those over there are not.” Resilience, as far as I can tell, isn’t an on-off switch. It’s a complex soup that is constantly in flux and motion. There is probably a sliding scale of tolerance, almost certainly mixed in with a bit of luck.
Next Up: More Research on What Works
All is not lost here: there’s a slowly growing body of research that is starting to back what types of programs might increase resilience. Jennifer Wild says such a program could be a type of therapy that targets modifiable risk factors (3). This type of program is meant to teach you different skills and tools to help manage the stresses, and pressures in your life. Often attributed to cognitive behavioral therapy, but not exclusively so, it is also designed to help identify faulty beliefs that may lead to trouble, and to teach you what it feels like to need to shake those beliefs. Its main aim is to offer structured treatment for depression and anxiety, but like a lot of interventions, whether behavioral or pharmaceutical, the side effects are sometimes positive. It could be that through the specific targeting of modifiable factors—things we could reasonably change—we can then train a firefighter to withstand more of the pressure of the stresses by offsetting the potential negative belief and coping styles they would had otherwise used.
Resilience, as used today, has at least two meanings. This isn’t often well understood, either by the program developers or the front-end users. It’s a buyer-beware situation, and requires firefighters to understand enough about their situation to be able to discriminate and determine their mental health needs.
REFERENCES
1. Ross Edgely; The Art of Resilience: Strategies for an Unbreakable Mind and Body.
2. Krakauer, R. L., Stelnicki, A. M., & Carleton, R. N. (2020). Examining mental health knowledge, stigma, and service use intentions among public safety personnel. Frontiers in psychology, 11, 949.
3. Wild, J., Greenberg, N., Moulds, M. L., Sharp, M. L., Fear, N., Harvey, S., … & Bryant, R. A. (2020). Pre-incident training to build resilience in first responders: recommendations on what to and what not to do. Psychiatry, 83(2), 128-142.
Nick Halmasy has been a firefighter for 13 years and is currently with the Selwyn Fire Department in Ontario, Canada. He is a master’s-level, registered psychotherapist and research collaborator associated with McMaster University and Queen’s University in Canada and founder of After The Call, a free mental health resource for first responders.
