By Lorenzo Norris, MD

In the age of COVID, what exactly does it mean to be optimistic? I get this question quite a bit from virtually everyone I meet in one form or another through my work with the GW Resiliency and Well-Being Center. Giving a lecture on resilience and staying positive can be a significant challenge.

Especially when we wake up to the news that 1 of every 100 older Americans has died secondary to COVID. The mind doesn't really know how to process this type of loss. It is hard to maintain any form of a positive attitude when you're still struggling just to accept the magnitude of what humanity has experienced over the past 2 years.

In Resilience: The Science of Mastering Life's Greatest Challenges, (Southwick and Charney, 2018), the authors identify 10 critical factors associated with very resilient individuals. The authors based their work on science, personal experience, and interviews of people who have literally been through hell and back. One of the critical factors they identified is optimism.

"Optimism ignites resilience, providing energy to power the other resilience factors. It facilitates an active and creative approach to coping with challenging situations."

Southwick and Charney are a lot smarter than me and far more patient to weave all this data together into a coherent story about optimism. Sounds like a damn good factor to focus a lecture on in my book! Slight problem: In my experience, many health professionals are already expert optimists. They literally eat, sleep, and sincerely breathe this stuff. So if we are going to talk about optimism, then we need to discuss realistic optimism.

How does realistic optimism differ from, say, blind optimism? Southwick and Charney's review of the literature points to three features worthy of highlighting.

Realistic vs Blind Optimism: Take-Home Points

-In realistic optimism, we notice the negative but don't stay engaged with it. Realistic optimists moved on from problems that were not solvable.

-Blind optimism can involve optimistic biases that affect self-deception or convincing oneself of desired beliefs without reality checks.

-Blind optimism can lead to underestimating risk, overestimating abilities, and inadequate preparation.

Growing up in northeast Ohio, I can absolutely embrace the concept of realistic optimism. It's overcast in Cleveland 8 months out of the year. To hope for three sunny days in a row in April is genuinely a fools' errand. So you learn over time, the sun will shine; you just have to at times wait 3-4 months for it to occur.

From a skill perspective, realistic optimism could be conceptualized as a great mix of radical acceptance, emotion regulation, and focused problem-solving. This is all fine, but to be realistically optimistic, we must first stop wishing for a better tomorrow. You may say, I don't wish for or see rainbows and unicorns, et cetera, et cetera. Okay, so you don't verbalize your wishes, but on a small level, you may engage in wishful thinking. Here are a few wishful thoughts that I would daydream about, which were not realistically optimistic at various points:

"Once we get enough COVID-19 tests, things will improve."

"All we need to do is get vaccines, and then the new normal is right there."

"Once everyone gets the booster, then we got this thing beat."

At this point, you could argue that I was engaged in being blindly optimistic. I consider the above statements blind for a couple of reasons. They weren't balanced (both positive and negative), didn't have a clear definition of the outcome, and were more focused on external events I couldn't control. These statements were the equivalent of wishes, and I don't have a magic lamp with a genie, so I need to let go of my wishful thinking first. Let me rephrase that: I need to forcefully toss it into the sea of COVID variants and start figuring out how I'm going to tread water for another 6-12 months. So with this in mind, here are my initial thoughts on ways to navigate the next year of the pandemic:

A multilayered form of protection gives me the best chance to survive the next 6 months of the pandemic.

-It will take time, but I'll process the loss associated with a workplace that will never be the same.

-Until we have positivity test rates lower than 2% across the globe, COVID will remain a substantial disruption to humanity.

-I can't bring back missed graduation or the first day of school, but I can share ways that I've countered and survived loneliness in my life with my children.

Okay, this is the starting point — hopefully not pessimistic, or blindly optimistic, just realistic. Now I can address other important topics, such as planning to rebuild my disappointing fantasy football team. I was number one in our GW Department of Psychiatry Fantasy Football League until my star running back Derrick Henry went down. My residents will become attendings and still give me grief about this for many years to follow, and that is a very good thing.

Everyone be well and safe.