There is no question that as Canadian health care providers working in a system that is collapsing, paramedics are under unprecedented stress. Paramedicine has long been referred to as a profession that is unsustainable, with people widely referencing data indicating that the average years of service is 5 years or less due to physical and mental stressors. (Hollie Backberg, 2019) There are more recent anecdotal claims that in today’s arduous health care climate that number has significantly decreased. Additionally, it has led to those who have beat the odds with over 5 years of service to retire earlier than they had planned. We are in critical need of research and education on how to make paramedicine a career that is sustainable. A career that a person can not only retire from but do so without mental and/or physical injury.
Without these efforts, the profession of paramedicine will become a steppingstone to other professions rather than a career its own. It will be robbed of experienced leaders and mentors to support the generations to come and legacy will cease to exist within this profession. Perhaps the most concerning of all the consequences is the growing number of paramedics leaving this career injured with their quality of lives forever impacted.
While there is a significant deficit in research and education around making paramedicine a sustainable profession, what does exist is primarily around resiliency. While work around resiliency is unquestionably important, its focus is on surviving adversity. In this article I want to discuss the newer concept of Antifragility and how it could be an important piece in switching from surviving the career of paramedicine to thriving in it.
Resiliency and Antifragility
Resiliency derives from the Latin word Resilire meaning to recoil or to bounce back from. (Resilient, 2017) In psychology, the concept of resiliency is about the ability to both withstand and recover from the impact of adversity. (Katie Hurley, 2022)
The very definition of resiliency suggests that we hold strong, bounce back, or break from hardship. However, the very idea of “bouncing back” suggests that when going through hardship you can come out the other side unchanged. When in fact adversity is transformative by nature. Understanding that once impacted by adversity one does not return to the exact person they were before leaves us with “to hold strong” or “to break” within the resiliency narrative. Perhaps the most important piece to this narrative that is missing is that “to grow” from hardship is possible.
The concept of Antifragility speaks to this missing narrative and gives us the platform and the language to start building on our understanding of health and healing. The term was coined in 2012 by professor Nassim Nicholas Taleb to describe systems that don’t just withstand stress but improve as a result of it. (Taleb, 2012) While the concept has been used in various fields since, including computer science, engineering, and physics, it was Harvard professor Dr. Tal Ben-Shahar who first applied Antifragility to mental well-ness in 2020. (Ben-Shahar, 2020) Antifragility is not about bouncing back from but rather becoming stronger and benefiting as a result of adversity. (Don’t Chase Happiness. Become Antifragile – Tal Ben-Shahar, 2022) It’s taking that inevitable transformation that comes with hardship and turning it into growth.
Antifragility in Nature
Anti-fragile systems are intrinsic to nature itself. (Equihua, et al., 2020) Systems that are constantly adapting to stressors in ways that make it stronger. It’s the heart of evolution. The human body is arguably more of an anti-fragile system than it is a resilient one. The immune system relies on adversity/exposure to pathogens to grow stronger to protect us. Under stress muscles grow stronger and bones get denser. When skin breaks, the tissue that replaces it, colloquially known as “scar tissue”, is stronger than what it replaced. All these systems are not designed to recover or bounce back under stress. They are designed to adapt and grow stronger under stress. Alternatively, if these systems falter under the stress they become injuries that haunt us. In the same way that we can look after our bodies so that they are more likely to strengthen under pressure than break, we can look after our minds to foster the same anti-fragile systems. This is the concept of antifragility in the context of mental wellness.
Fostering Antifragility isn’t anything fancy or complex. It’s about looking after ourselves on the most basic level. Just as our bodies have anti-fragile systems that work best when we look after ourselves, our minds too have those systems. Systems that require the same effort and care in order to serve us well. Dr. Tal Ben-Shahar proposes that there are five aspects of wellness to looking after the mind in order to foster its anti-fragile potential: spiritual, physical, intellectual, relational, and emotional. He refers to these as the five aspects of total wellness under the acronym SPIRE. (Don’t Chase Happiness. Become Antifragile – Tal Ben-Shahar, 2022)
For the purpose of this article, I will only be scratching the very surface of these aspects of wellness. I strongly encourage readers to pursue Dr. Tal Ben-Shahar’s work for a more complete understanding of this framework and for more actionable take-aways.
The spiritual aspect of wellbeing is about having meaning and purpose in life. Studies have shown that having a sense of purpose makes one more adept at responding to emotional challenges and growing from adversity. (Schaefer, et al., 2013) Having a sense of purpose has also been found to lead to decreased morbidity and mortality. (Schaefer, et al., 2013) Taking the time to anchor your “Why” can have a significant impact on your ability to grow from challenges.
The benefits of exercises extend beyond the physical body. Studies have found that exercise reduces anxiety and depression with the same efficacy as antidepressants allowing us to more effectively process hardship and turn it into growth. (Recchia, et al., 2022)
Curiosity is strongly linked to adaptive behaviour, life satisfaction, and meaning. (Kashdan & Steger, 2007) (Vermeer, Muth, Terenzi, & Park, 2022) Through curiosity, people find ways to understand, process, and grow through challenges.
Developing strong healthy relationships is the strongest predictor in being able to grow through hardship. (Don’t Chase Happiness. Become Antifragile – Tal Ben-Shahar, 2022) Strong social structures are not only important for mental wellness, studies have also indicated that they lead to longer healthier lives. (Miller, 2021) Investing in relationships with family and friendships is an important part of turning adversity into strength.
Gratitude is an easily overlooked aspect of emotional wellness, yet, its impact is quite profound. Practicing gratitude has been found to measurably improve outlook and relationships both of which are important factors in growing from adversity. (Giving thanks can make you happier, 2021)
While far from the whole picture or complete answer, together resiliency and antifragility can be the beginning of preventing the end of the paramedic profession as a career. It can be the start of a narrative on thriving in this profession over surviving it. By figuring out our “Why”, investing in our relationships with our families and friends, staying curious, spending time looking after ourselves through exercise, and practicing gratitude we are actively building anti-fragile minds and lives.
This won’t guarantee mental wellness, but I am hoping that it could give us a fighting chance and open-up important discussions around what thriving could look like in this profession.
I would be remiss not to acknowledge that there is a lot that must change systemically, environmentally, and ergonomically in order to make this profession truly sustainable. Together, we must advocate for and work towards more research and education on ways we can make it to retirement and do so without injury. Ways to make this profession one that we encourage our children to follow our footsteps into rather than discourage them from because we know all too well of the toll it takes.
Ben-Shahar, T. (2020, 12 04). The Science of Happiness: Antifragility in Difficult Times. Retrieved from Columbia SPS School of Professional Studies: https://sps.columbia.edu/events/science-happiness-antifragility-difficult-times
Brown, H. (2022). How Curiosity Can Boost Our Well-Being. Retrieved from The Upside: https://www.happify.com/hd/how-curiosity-can-boost-our-wellbeing/
Don’t Chase Happiness. Become Antifragile – Tal Ben-Shahar (2022). [Motion Picture].
Equihua, M., Aldama, M. E., Gershenson, C., Lopez-Corona, O., Munguia, M., Perez-Maqueo, O., & Ramirez-Carrillo, E. (2020). Ecosystem antifragility: beyond integrity and resilience. PubMed, 8.
Giving thanks can make you happier. (2021). Retrieved from Harvard Publishing. Harvard Medical School.: https://www.health.harvard.edu/healthbeat/giving-thanks-can-make-you-happier
Hollie Backberg, N. A. (2019, 03 04). Stress: The Silent Killer of the EMS Career. Retrieved from EMS WORLD: https://www.hmpgloballearningnetwork.com/site/emsworld/article/1222339/stress-silent-killer-ems-career
Kashdan, T. B., & Steger, M. (2007). Curiosity and pathways to well-being and meaning in life: Traits, states, and everyday behaviors. Motivation and Emotion.
Katie Hurley, L. (2022, 07 14). What Is Resilience? Your Guide to Facing Life’s Challenges, Adversities, and Crises. Retrieved from Resilience Resource Center: https://www.everydayhealth.com/wellness/resilience/#:~:text=Resilience%20is%20the%20ability%20to,through%20emotional%20pain%20and%20suffering.
Miller, M. (2021). What makes a good life? 3 Lessons on life, love, and descision making form the Harvard Grant Study. Retrieved from Six Seconds. The emotional inteligence network: https://www.6seconds.org/2021/04/19/harvard-grant-study/
Recchia, F., Leung, C. K., Chin, E. C., Fong, D. Y., Montero, D., Cheng, C. P., . . . Siu, P. M. (2022). Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials. British Journal of Sports Medicine.
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Schaefer, S. M., Boylan, J. M., Van Reekum, C., Lapate, R., Norris, C., Ryff, C., & Davidson, R. (2013). Purpose in Life Predicts Better Emotional Recovery from Negative Stimuli. PubMed.
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Vermeer, A. B., Muth, A., Terenzi, D., & Park, S. (2022). Curiosity for information predicts wellbeing mediated by loneliness during COVID-19 pandemic. Scientific Reports.