Strength in the face of adversity: individual and social thriving - Thriving: Broadening the Paradigm Beyond Illness to Health

Recovery (Panel B) indicates a return to baseline. After the decrement associated with an initial challenge, the individual is able to return to previous levels of social and psychological functioning. In the case of breast cancer, following treatment, a woman's energy returns, and she is able to resume her daily personal and professional activities much as before her illness.

Thriving (Panel C) represents the ability to go beyond the original level of psychosocial functioning, to grow vigorously, to flourish. Through the interactive process of confronting and coping with challenge, a transformation occurs. The individual does not merely return to a previous state, but rather grows beyond it, and in that process adds value to life. This conception of thriving differentiates O'Leary and Ickovics' (1995) model of resilience from prior formulations. In that model, thriving may be manifested in three domains: behaviorally, cognitively, and emotionally.

Thriving is transformative. It is contingent on a fundamental cognitive shift in response to a challenge. Challenge provides the opportunity for change because it forces individuals to confront personal priorities and to reexamine their sense of self. It can alter social roles, resulting in the acquisition of a new role (e.g., role of patient), loss of an old role (e.g., parenthood, after the death of a child), or a reordering of role priorities (e.g., recognition that it is more important to focus on interpersonal relationships than career success).

For such a transformation to occur, the challenge must be profound, an event such as facing a fatal illness, a severe traumatic accident or victimization, a great loss, or an existential crisis - events that shake the foundation of one's life, calling into question one's sense of purpose, meaning, or identity. These events are at the extreme because these are the ones that provide the greatest opportunity for a heroic response.

These concepts are illustrated in the "real life" of one woman, a psychologist first diagnosed with breast cancer in 1990 and diagnosed with metastasized breast cancer a year later. She has continued her work as a university professor, teaching, researching, and providing service throughout surgery, radiation, and chemotherapy. Sara Snodgrass (this issue) reports having faced cancer with increased self-confidence and a belief that she can handle just about anything life dishes out. She describes her post-challenge self as more easygoing and happier. She acknowledges that life is more meaningful now, and she reports that other women in her cancer support group share this view. She attributes some of her growth to her spirituality, a belief that everything she encounters, positive or negative, provides an opportunity for growth. Her personal priorities have shifted. She describes the last 8 years of her life as the best 8 years, despite the pain, the fear, and the uncertainty she readily acknowledges as a part of her experience. Before her bone marrow transplant, she hoped for a cure; now she talks about fighting cancer for the rest of her life. She has gone beyond survival and recovery; she is thriving.