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Resilient due to the job?

Three people died and many others were injured in a

multiple pileup on the A31 in North Rhine-Westphalia.

Emergency workers shielded the accident from those

who perhaps wouldn’t have been able to cope with it –

and ultimately needed to muster a lot of strength

themselves to come to terms with what had happened

The Strength of

Work-related stress, private problems, or other worries:

everyone finds themselves in a stressful situation at some point

in their lives. Resilient people MASTER CRISES MORE EASILY.

Some people are born with such abilities, while others acquire

them – people, companies, or even entire cities.

Text: Isabell Spilker

6 DRÄGER REVIEW 111 | 2 / 2015


MENTAL STRENGTH

FOCUS

PHOTO: DDP IMAGES

the Resilient

DRÄGER REVIEW 111 | 2 / 2015

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FOCUS

MENTAL STRENGTH

T

The emergency call was received by the call center at

9:33 a.m. What happened in the hours that followed would require

thousands of workers and drive them to the limit of human

tolerance. In March 2009 a former student of a school in the

small town of Winnenden in Baden-Württemberg shot dead 15

people – and ultimately himself. Martin Luitjens was

also on the scene. As a leading emergency pastoral

care worker he took care of the survivors and emergency

crews by being there to talk to them. By the

time evening came, the man who usually helps others

to cope with traumatic experiences noticed that

even his strength was waning. Emergency crews who

have to recover children’s bodies, police officers who

witness their colleagues being gunned down – they

all work in these inhuman situations. Once everything

has calmed down, stress takes its toll. However, those

who do not possess the mechanism that psychologists

call “resilience” will have big problems coping with

their everyday lives. “People who come home after such a day at

work are not initially in a position to come to terms with what has

happened,” says Luitjens, who also works as a resilience coach.

“They are disoriented at first, because the psyche needs time.”

Some people pull themselves together within a few days, while

others need months, sometimes even years – or an entire lifetime.

Tolerance to disruptions

Resilience describes the psychological ability to cope with and

recover from difficulties. The concept can be assigned to systems,

organizations, infrastructures, materials, and entire societies.

Across a number of different disciplines it describes people’s

tolerance to disruptions – and the ability to take the measures

needed to ensure that the serious situation doesn’t even occur in

the first place or at the very least mitigate its impact. This works

in a hospital as much as within other complex systems. An example:

in recent years the impact of climate change on cities has

been analyzed. The focus of the analysis was on how the cities

8 DRÄGER REVIEW 111 | 2 / 2015


The noise was alarming, the scene incomprehensible:

on June 3, 1998 the high-speed ICE train “Wilhelm Conrad

Röntgen” derailed in Eschede near Celle. The train accident was

the first major catastrophe in Germany in which the emergency

crews received systematic follow-up care. A total of 700 of around

2,000 workers took advantage of the assistance over a period

of three years; 100 had long-term problems – they suffered from

internal unrest and could barely sleep

Resilience

can protect the

mind – like an

immune system

manage to brave the extreme weather and return to normality as

quickly as possible afterward. An aptitude for learning is a further

dimension of this robustness and capacity to cope. A resilient

system is in a position to learn and adapt to changing conditions.

“In relation to people, resilience describes the mechanisms

which ensure that they emerge stronger from stressful and demanding

situations,” explains Michèle Wessa, professor of clinical

psychology and neuropsychology at the Johannes Gutenberg

University in Mainz. Europe’s first center for resilience research

opened here in the summer of 2014 with the aim of understanding

the principles of resilience on a molecular and neuroscientific

level and by conducting animal experiments. The idea is to develop

new prevention methods on the basis of the findings.

The demand for effective concepts is rising. The psychological

constitution of man has become a popular subject. Despite

increased prosperity and (compared to bygone days) lower lev-

PHOTO: DPA/SÜDDEUTSCHE ZEITUNG PHOTO

els of physical exertion, many people are under enormous pressure

both at work and at home. If you are unable to keep up, you

lose – at least that’s how it seems to many people. General studies

of the mental health of employees in medical careers reveal,

for instance, that at least 20 percent of doctors suffer from burnout

syndrome. Work-related stress is one of the biggest challenges

of the present age. Resilience is the flip side of it all and the

thing that can protect people – like a callus.

“What doesn’t kill me only makes me stronger”

Yet how is this protection mechanism formed? Systems can be

made more resilient, but people? Resilience can protect the mind

and prevent illness after intensive negative experiences. And just

like an immune system it is more pronounced and effective in

some people than in others. So why are some people more resilient

than others? Is it genetic, is it acquired

during childhood, or does it develop during TOUGH SHELL

the transition to adulthood? Or can resilience

The American

evolve at any of these stages? The formula Psychological Association

could be simple. An essen tially optimistic child has developed a

is not wrapped in cotton wool by its parents, ten-point plan which

but is exposed to the oc casional crisis. He or can pave the way

she goes through life as a mentally strong adult to greater resilience:

and faces any adversity with an inner robustness.

Stephen Joseph carries out research in 2. Avoid seeing

1. Make connections.

precisely this area. He coordinates the psychotherapeutic

and practical psychology course problems.

crises as insurmountable

at the School of Education at the University

of Nottingham and was head of the Cen-

is a part of living.

3. Accept that change

tre for Trauma, Resilience and Growth there

4. Move toward

your goals.

until 2013 as professor of psychology: “Many 5. Take decisive actions.

of the skills that adults possess are the result 6. Look for opportunities

of training during childhood. We must learn for “self-discovery.”

how to cope with difficult situations. Those 7. Nurture a positive

who are confronted with adversity and catastrophe

will show a higher degree of resilience

view of yourself.

8. Keep things in

perspective.

9. Maintain a hopeful

outlook.

10. Take care

of yourself.

DRÄGER REVIEW 111 | 2 / 2015

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MENTAL STRENGTH

“The culture

within the organization

will also

determine how

resilient emergency

workers are”

if they have learned from early experiences.” Accordingly,

he also essentially sees the positive side of crises

and concurs with Friedrich Nietzsche’s Twilight of

the Idols: “What doesn’t kill me only makes me stronger.”

Stephen Joseph borrowed from Nietzsche for the

title of his book (What Doesn’t Kill Us) and tells stories

of people who have managed to emerge stronger

from setbacks. “Post- traumatic growth also means

learning from trauma: setting new priorities and finding

out what is really important.” However, those who

have no positive experience of coping with crises, that is to say

those who have been unable to come to terms with previous experiences,

will be more vulnerable. This has also been shown by

a study in which Joseph was involved in 1987 following the ferry

disaster near the Belgian port of Zeebrugge in which 193 people

died. Survivors who had to deal with further crises (such as

a severe illness or the loss of a relative) in the three years afterward

proved to be even more vulnerable than a reference group.

“Those who are as cool as a

cucumber are by no means resilient”

Something else became clear from the study: people who were

unable to show their feelings and who lacked social support fared

especially badly. A finding also shared by resilience coach Luitjens:

“Social support is a driving factor. Resilience has a great deal to

do with the personal environment – as in the case of emergency

crews, for instance. The culture within the organization will

also determine how resilient they are.” Is it not possible to simply

talk to one another after a callout and just say that something

didn’t go so perfectly? “Structures which live by the myth

of being invulnerable and in all probability being able to remain

as cool as a cucumber make it difficult to deal with demanding

situations. In such an environment hardly anyone has the courage

to admit to a supposed weakness.” In his opinion and experience,

social resources – in other words, the support within the

group – are the crucial factors which lead to greater resilience.

The researcher Michèle Wessa goes one step further here: “The

link is not as strong as people thought. Although these attributes

and factors (optimism, social support, and early experiences) do

have a significant influence, they are not sufficient to predict how

resilient an individual will be in a situation.” Resilience is probably

a combination of different factors and mechanisms. “If it were

merely attributes that made us resilient, then somebody would remain

resilient throughout their entire life. But that isn’t the case.

An example: many emergency workers go through their professional

lives without suffering any damage – and then something

suddenly knocks them off their feet. This seems to confirm that

there are resources which are somehow built up over time, but

can also be exhausted at some point.

Inherent feature of many training courses

The German Resilience Center is trying to catch this moment

with a specially established outpatient clinic. It is not aimed at

people who are in the middle of a crisis and are in desperate need

of resilience; it is more for stressed people and institutions before

the first serious situation occurs so that it can be countered

Entering the

water with the

hope of finding

survivors,

only to recover

bodies:

the Costa

Concordia maritime

accident off

the Italian coast

demanded mental

strength from

the diving team

10 DRÄGER REVIEW 111 | 2 / 2015


Interview

Resilient

equipment

Five years ago Dräger set up a

division which tests medical-technical

equipment in more practice-based

settings, making it more resilient to

adverse environmental influences.

Dirk Zumtobel is head of the product

reliability division.

Mr. Zumtobel, quality assurance

is taken for granted these days.

What do you do to go further?

Zumtobel: The conventional standards

applied to functional testing in

the area of quality assurance were

no longer sufficient for us. We

also test system stability over a longer

period of time – and under “clinical

conditions.” Flawless components do

not necessarily produce a perfect

system. This is precisely what we work

on: we make sure that our components

are free from defects and function within

the overall system in everyday use.

Have you built a small hospital

for this purpose?

Zumtobel: Yes, kind of. In our

quality lab we are technically in

a position to simulate everyday

clinical situations. We subject 25 or

more devices of a certain type

to stress under various conditions,

record the results, and evaluate

them statistically. This makes it

possible to give statements

about the robustness and reliability

of our systems in the field.

What conditions do you subject

the equipment to?

Zumtobel: As many predictable ones

as possible – severely obese patients,

premature babies (who need to be

gently ventilated), regular disinfection

measures (with various detergents

and methods), temperature and pressure

changes, power supply fluctuation,

and many more besides.

What were the initial findings?

Zumtobel: After the first test runs

with prototypes we were surprised at

how many events were actually

recorded. Not everything is immediately

noticed by the user. It revealed to use

the areas where the system architecture

is still “shaky” – in a similar way to a

PC system which can also occasionally

hang during an application.

So the equipment is made

resilient against itself in

the first instance. What kind

of external influences must

it also be protected from?

Zumtobel: The biggest challenge

confronting technology is actually the

user. Everything is generally OK

as long as the equipment is used in

accordance with the operating

instructions, if there were no “foreseeable

misuse.” To this end, we regularly

let people with clinical and technical

knowledge operate our new technologies

without formal product training. In

addition, we subject the equipment

to further unpredictable situations: the

use of unsuitable accessories, switching

it off suddenly, incorrect cleaning, and

much more besides. This gives us

more insight which helps us to make

the equipment even more resilient

during the development phase.

DRÄGER REVIEW 111 | 2 / 2015

11

PHOTO: PICTURE ALLIANCE/DPA


FOCUS

MENTAL STRENGTH

accordingly with stress management and relaxation techniques

as well as a social network which offers assistance. Measures

that promote resilience are often an inherent feature of training

courses for firefighters, police officers, and pilots. It is important

to realize the following: “There is no such thing as resilient or not

resilient! Every individual has a certain limit which is

sometimes sufficient for the challenges they face –

but sometimes they go beyond this limit,” says Martin

Luitjens. It took three days for him to regain his composure

after his experiences in Winnenden. “Naturally

I know about the coping process and what I need to

do to get back on my feet.” Luitjens is well equipped.

However, he also knows that even though an individual

reacted resiliently to a certain situation last year,

it doesn’t necessarily mean that they will do so again

on the next occasion. Nothing can be predicted, but

everyone can arm themselves against it.

LITERATURE AND LINKS

Stephen Joseph: What Doesn’t Kill Us.

288 pages, Jackson/TN, USA, Basic Books, 2013

Karen Reivich, Andrew Shatte: The Resilience Factor:

7 Keys to Finding Your Inner Strength and Overcoming Life’s Hurdles.

352 pages, Harmony Publishers, New York, 2013

American Psychological

Association:

www.apa.org/helpcenter/road-resilience.aspx

Resilence Training Institute

(Branches throughout the USA)

www.resiliencetraininginstitute.com

“There is no such

thing as resilient or

not resilient!”

12 DRÄGER REVIEW 111 | 2 / 2015


Even though the job requires a certain

robustness, the image of the tough firefighter has

changed in recent years. Nowadays, emergency

workers can admit that callouts lasting several hours,

such as this major fire, can really get to them

HOW STRONG IS YOUR MENTAL IMMUNE SYSTEM?

People react very differently to demanding experiences. This

is primarily due to their individual mental resilience. Take this

test to determine how resilient you are. Mark the box which

generally indicates the extent to which the following statements

apply to you. Add up all the points at the end – you can

check your score below.

1. When I have plans, I see them through.

1 2 3 4 5 6 7

2. I usually manage to do everything somehow.

1 2 3 4 5 6 7

3. I am not thrown off

course that easily.

1 2 3 4 5 6 7

4. I like me.

1 2 3 4 5 6 7

5. I can multitask.

1 2 3 4 5 6 7

6. I am decisive.

1 2 3 4 5 6 7

7. I take things as they come.

1 2 3 4 5 6 7

8. I take an interest in many different things.

1 2 3 4 5 6 7

9. I can usually see a situation from more

than one perspective.

1 2 3 4 5 6 7

10. I can also force myself to do things that

I don’t really want to do.

1 2 3 4 5 6 7

11. When I am in a difficult situation, I usually

find a way out.

1 2 3 4 5 6 7

12. I have enough energy to do all the things

I have to do.

1 2 3 4 5 6 7

13. I can accept the fact that not everybody

likes me.

1 2 3 4 5 6 7

Based on: Karena Leppert et al, Klinische Diagnostik und

Evaluation magazine, 2008, pp. 226–243; with permission.

SCORE

58 points or less: You are not very

resilient. However, this does not

mean that you are at the mercy of

life’s difficult situations, but you

are more likely to need help working

through a challenging situation

than others who are confronted with

the same difficulties.

59 to 82 points: You have average

resilience. You can normally

deal with difficult situations and get

back on your feet after a little while.

83 points or more: Nothing throws

you off course easily. You have

the ability to react flexibly to adversity

and find a strategy appropriate

to the situation. If you are unable to

change a difficult situation,

you are generally able to accept it.

PHOTO: ULLSTEIN BILD – CARO/MARIUS SCHWARZ

DRÄGER REVIEW 111 | 2 / 2015

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