Health, Spirituality and Medical Ethics

Resilience, one of the most important religious doctrines, has been always recommended in Islam along with patience in the face of the growing problems in life like violence. Resilience is one of the most important factors that help people cope with difficult and stressful life situations [1, 2].
In the existing literature, resilience is the opposite of impatience. People with a low level of tolerance get impatient and lose their temper in the face of problems and calamities. However, individuals who have a good or high tolerance level do not become impatient, and life pressures do not disturb their mental and behavioral balance. Humans are tested by God in different ways, in which patience and resilience become important and shape the human personality or stabilize them in terms of personality [3]. Also, Resilience serves important functions in daily life at the individual and social levels and can be increased by raising the level of knowledge and awareness, religious faith and belief, reliance on divine promises, trust, optimism, and hope [4]. The majority of resilience-related evidence has been on the national [1, 5], social [4], psychological [6], and organizational [7] scales, sometimes based on Islamic and religious doctrine [8-10].
A review of the existing literature shows that resilience stems from a dynamic interaction of several factors, such as faith, trust, patience, consent and subservience, belief in divine will/wisdom concerning punishment, reward, agony, and many other things concerning religious and Islamic instructions. Within this dynamic system, each factor purposefully affects the level of resilience within an individual. However, in none of the available documents, there is any evidence of comprehensive modeling of this important issue according to the propositions involved in the formation of this phenomenon in people based on religious attitudes and doctrine as well as a system dynamics perspective. Accordingly, this study evaluates the structure and model of resilience at the individual level based on religious and doctrinal teachings in the form of a dynamic model.
Theoretical and conceptual framework of the model
In the literature, resilience is tied with elasticity and reversibility conceptions. In psychology, resilience also refers to a dynamic process of positive adaptation to tragic experiences in life. The core of all definitions lies in the adaptation to hardships in life despite all the existing obstacles. In the Holy Quran, the concept of resilience is tied to the word patience. Patience is also defined as tolerance and endurance [4]. Based on the evidence in religious sources, the four elements of patience, trust in God, faith in divine wisdom, and will and piety are the most important components needed to create individual resilience; however, each of these components includes elements which, along with other elements in other components, are important and conceivable in the form of a dynamic system for orienting the concepts of individual resilience. Accordingly, these four elements are included in this study as the main structure of the theoretical and conceptual framework: Belief in divine wisdom/will, trust in God, patience, and piety. These variables interacted with each other in the target system. In the following section, each of the subsystems was drawn separately first and then all integrated within a comprehensive model of individual resilience at the end.
Methods
Study type
This is a narrative review that carefully reviewed the related literature on resilience in religious publications to develop a dynamic model in 2022 for individual resilience based on religious doctrine.
Description and nature of the model
The system dynamics approach is the use of feedback loops, flow, and state variables that help to understand the system behavior [11]. The causal loop diagrams are the best means of unraveling the structure of interactions and feedback within the system [12]. They form the system conceptual model. These conceptual models facilitate the process of discussing and comparing different interpretations of system structure, which are the variables and the relationships between them as reinforcement and interactive feedback loops in the form of cause-and-effect diagrams, and form the so-called system dynamic [13].
In terms of work steps, briefly, the researchers, first, use an extensive review of the related literature about the system from internal sources in Iran, including ISD, SID, and Google Scholar databases, as well as exclusive databases of humanities and Islamic sciences journals in Iran. Also, using the keywords “individual resilience” AND “Islam” OR “religious and Islamic approach”, an extensive search was conducted in the databases of PubMed and Google Scholar without a time limit. In addition, paper sources, such as the Quran and some religious reference books, such as “Nahj al-Balagheh” or “Sahifah Sajjadiyeh” and “Bihar al-Anwar” were also used as auxiliary sources. Then, this study tried to propose a hypothetical model. Next, based on the hypothetical model and dynamic hypotheses formulated about the interactions among the components included in the system, a causal loop diagram was drawn.
Elements of the subsystems
In the belief in divine wisdom/will subsystem, there were several components, including consent and subservience, prayer and divine help, human nature, belief in the ups and downs of life, belief in divine tests, belief in punishment and reward, and responsibility. The patience subsystem further included problem-solving skills, self-efficacy, happiness, hope, calmness, flexibility and strong will, personality balance, challenge, self-esteem, positive thinking, and life satisfaction, as well as the interactions among these variables. In the trust subsystem, several other variables were included, such as purposefulness, contextual adaptation, belief in divine guardianship, attachment to God, and forgiveness. Finally, the piety subsystem examined the belief in death, remembrance of God, sociability, supporting loved ones, and keeping in touch with them.
Steps of the design establishment
To develop the dynamic model, the first step was to map the causal relationships between the variables included in the system. This section has been compiled based on the review of sources and the opinions of experts and its details are expanded in the next section. According to the causal diagram, the state-flow and auxiliary variables were determined and used to draw the state-flow diagram of the dynamic model. According to the purpose of the study, the procedure continued until the causal diagrams which drawn in Vensim software, version 7.3. Therefore, the quantitative modeling was not relevant to our study. To comply with ethical considerations, the principle of trustworthiness in extracting materials, quoting concepts, and transferring them to the audience from primary sources has always been considered by the authors, and the results have been declared honest, accurate, and complete. Also, the material and moral rights of all persons related to the research have been respected.
Results
Belief in divine wisdom/will subsystem
Concerning the belief in divine wisdom/will and how it is associated with resilience, the literature showed that belief in God and his wondrous creation of the universe is a main aspect of human nature. As God willed, there are things in the world that may not be pleasant to humans at first; however, our belief in the divine will and his wisdom plays an important role in strengthening the belief in difficulties in the form of divine tests and opening after hardship (ups and down of life) and subsequently in human resilience. This characteristic, which is always associated with patience and trust in God, makes individuals, with a faithful, logical, and rational view of all blessings and afflictions, adapt their souls and bodies to the life of this world, and in the face of hardships and misfortunes, be patient by believing in the system of divine punishment and reward and taking responsibility for problems, which is itself a manifestation of resilience. Furthermore, belief in divine wisdom/will makes us sure that God will help us in disasters and encourages us to be submissive to God’s will by praying and asking god for help. If this sense of subservience continues, happiness and hope follow, and finally we can adapt to the hard life and manage to overcome difficulties. In this regard, the concept of accompanying hardships and easiness in the world or reaching ease after enduring hardship, which naturally increases the hope and motivation to resist hardship, are other examples of hope and help from the divine essence as a product of faith and divine will. Belief in divine promises gives humans strength and endurance makes difficult situations easy for them and enhances one’s responsibility. Such a person, in a difficult situation and the face of unpleasantness, thinks about how he can please God to get closer to him more than ever before [4, 14, 15] (Figure 1).
Patience subsystem
Patience is an effective strategy suggested in religious literature for hard times in life. In the Quranic logic, patience does not simply mean the infiltration of sorrow; rather, it means not giving up, resisting hardships, and managing the stress that results from the problems. In the existing literature, different terms are used for individuals’ resistance to hardships to achieve higher goals in life. These include endurance, patience, strength, resilience, acceptance of the existing conditions, and controlling inner feelings [4, 16, 17]. According to the narrative sources and Islamic hadiths, patience has a broader meaning than resilience. The latter is a manifestation of patience within an individual. In the Holy Quran, patience is described as the most effective strategy to face different physical and mental pressures and its true meaning is resistance and endurance in serious life events, or when we have committed sins. If it lasts long enough, it will raise our spirits as we are living our lives [18]. In other words, in Islamic logic, patience is the best example of resilience in the face of difficulties. As for the subtle difference between patience and resilience, patience includes aspects such as anger control, lust control, endurance, fortitude and open-mindedness, problem-solving skills, self-efficacy and flexibility, and strong will. However, resilience conceptual constructs include tolerance, adaptation, reversibility, increased capacity, change, and rehabilitation. What contributes to patience includes emotion control, patience, perseverance, hope, and perfection in the development process. These all manage to strengthen the individuals’ will in the hardships of life and ultimately help to grow patience [1]. Patience as a main construct of mental health plays a major role in redressing personality balance and improving one’s openness to challenge. It can further increase self-esteem, positive thinking, life satisfaction, hope, happiness, and calmness. These all together within a system, are important preconditions for resilience [1, 6, 19, 20] (Figure 2).
Trust to God subsystem
Trust is another important factor in strengthening individuals’ resilience. In the field of trust, a person who faces problems beyond their ability feels lonely and appoints a more capable person as their advocate. In religious doctrine, we have been always advised to rely on the infinite power of God and admit an unconditional acceptance of his guardianship [21] as the most effective way of coping with difficulties. Moreover, trust in God significantly affects attachment to God, which also influences resilience [22]. Therefore, God is the best reliable source to appeal to in the face of life’s hardships. The trustworthy man believes that the divine will, which prevails over every other will, is never defeated and is superior to any power and infinite. Self-esteem, problem-solving skills, purposefulness, environmental adaptation, and responsibility help to overcome barriers to happiness. They help to increase endurance when intermingled with patience, hope, and calmness as well as forgiveness. These together can contribute to resilience [23-25] (Figure 3).
Piety subsystem
Piety means self-control in obeying divine commands, avoiding sins, and always remembering God in all circumstances. Developing piety in an individual prepares them to be thankful to God, increase patience, reform deeds, and believe in the immortal world and death [26]. This gratitude and acceptance of immortality [21] paves the way for submission to God, satisfaction, happiness, calmness, patience, and finally resilience in the hardships of life. Piety is a kind of belief in a powerful force acting on the activities of the value system derived from inner piety. It focuses on the deepest values and subsequent actions of individuals, the purity of motivation, emotions, and inner laws, and analyzes emotions. Devotion to relatives is mandatory in Islam and has been emphasized along with piety. The manner of devotion to relatives may differ across cultures due to the distance and proximity of relatives’ homes. Moreover, it does not only mean that we should be warm and friendly to relatives, but also means to support them emotionally and financially. Thus, it can be a good way to build up our loved ones’ support (sociability) and increase our tolerance level for hardships and divine tests [27] (Figure 4).
Integration of subsystems into a model of individual resilience system
As mentioned previously, the main underlying factors of the resilience construct were belief in divine wisdom/will, trust in God, patience, and piety. The components of each subsystem were examined in interaction with each other. Given the complexity of the intertwined interactions of these four factors with each other, it is misleading to conceive of resilience without these complexities and interactions. Each of these factors plays a certain role in resilience overall and also in each of the other factors. As perceived in the Quran and hadiths, and from a systemic point of view, several suggestions have been made about the role of patience and how it is associated with resilience. Examples are its role in controlling human anger and other similar natural reactions, coping with human stress and mental pressures, and the developmental role it plays in creating hope, satisfaction, and happiness. Thus, if mixed with a Godlike attitude, patience can help to control tensions and prevent stress [19].
The holy Quran drew attention to the secondary effects of piety on resilience; thus, it has mentioned devotion to relatives as a strengthening factor for social support spirits, cooperation, affection, and piety. Also, the association between human physical and mental health as the prerequisite for self-efficacy problem-solving skills, and personality balance, which is an important factor in human patience, is undeniable in religious beliefs and behaviors. The components of the piety subsystem seem to have the greatest impact on strengthening and interacting with the components of other subsystems. According to Islamic thoughts, well-balanced individuals are those who have created meaningful relationships between their logic and emotions. By doing so, they maintain the God-given balanced personality and do not go to extremes. People who have a well-balanced personality are capable of appropriately organizing their minds and feelings and are also patient. In the face of pressures and calamities, they act in a way not to hurt anyone else. They prefer to hurt themselves rather than let others take offense. Thus, they are highly tolerant and patient [3].
Concerning the support of loved ones, highly recommended in Islam, it is noteworthy that a key benefit is that at hard times in life, we can count on relatives’ support and can grow more hope in life. Scientific psychology research has also shown that the development of healthy social relationships, in addition to spiritual and spiritual benefits has many psychological benefits too. Examples are stronger positive emotions that can repel negative feelings and energies, gaining social support, acquiring social skills, self-regulating behaviors while communicating properly with others, and feeling more responsible. Also, this important belief increases human resistance to pressures and reduces grief and suffering in difficult divine tests. Finally, overcoming difficulties in life with the personality traits highly recommended in Islam such as piety, faith, patience, and trust in God’s will and their origin as briefly discussed can significantly strengthen resilience and the spirit of resistance. It is our endurance in hard times that creates a positive cycle of this trait and allows us to continue it in life as a true by-product of following religious rules and regulations [4, 28-30].
The effects of faith in divine wisdom/will in life events include stronger individual beliefs in innate concepts, belief in the ups and downs of life, and praying to God and appealing to him for help. These all, in turn, will increase our consent to and subservience to God’s will. The main effects of prayers, satisfaction, subservience to and belief in God’s tests in life hardships are happiness, calmness, and hope, which are the main constituent elements of patience. Hope for God’s help and maintenance of high spirits in hard times help us to adapt to the environment through attachment to God and accept his guardianship. What follows is greater patience and tolerance in the face of problems. These all help to increase a true believer’s self-esteem in the ups and downs of life. Higher self-esteem can increase our problem-solving skills and adaptability to hard conditions and increase openness to challenge. These are all major factors underlying a higher sense of satisfaction. Those with a high level of satisfaction and consent keep thinking positively in critical conditions overlook many difficulties in life with enough patience and try to abide by Islamic principles so that they can safely overcome problems and succeed with enough patience (Figure 5).
Discussion
The present study used a dynamic systems approach to explore individual resilience from the point of view of Islam and hadith. To this aim, the existing religious literature was reviewed to develop a comprehensive model. There is evidence for the effective role of the four subsystems of resilience consisting of belief in God’s will/wisdom, trust in God, piety, and patience and their components which are constantly interacting with each other dynamically. These include consent and subservience, prayer and appeal to God, human nature, belief in ups and downs of life, reward and punishment, responsibility, problem-solving skills, self-efficacy, happiness, hope, calmness, flexibility, strong will, balanced personality, openness to challenge, self-esteem, positive thinking, life satisfaction, contextual adaptation, belief in God’s guardianship, attachment to God, forgiveness, belief in death, remembrance of God, sociability, family support and devotion to relatives. These were dynamically interconnected and formed individual resilience from the Islamic point of view.
According to the Quranic teachings, God’s tradition of testing human beings is an integral part of worldly life. In the Quran (Surah Ankabut, Verse 2), God referred to these tests as a divine tradition affecting all humans and as a way of unraveling the personality of each individual, the degree of faith and belief, the strength of will, capacity, talents, and capabilities. In worldly life, these tests appear in the form of different hardships and difficulties. Human beings, at the core of these divine tests, can endure and get through the hard times using their existential potentials guided by religious instructions. This tolerance or endurance requires the recognition of all existential potentials of human beings and their mutual relationships, which cannot be fully represented unless in a comprehensive systemic model. That is because human growth in all aspects, as perceived in Islam, follows from the development of all capabilities as a network. None of the above-mentioned components are to be taken independently. Thus, we need a broader view to consider all aspects of the construct and the related divine sources to map this all-inclusive development. There are different models of human resilience to hardship that contribute to human growth, transcendence, and success in all divine tests. Yet, what they all lack in comparison to the present Islamic model is a systemic and harmonic view of the sub-systems and components of resilience. On top of them are the different paradigms to analyze the conceptual construct of resilience that is religious vs. non-religious. As an instance, Masten and Reid proposed a conceptual model of resilience comprised of variable-centered and individual-centered models. The former measured the cumulative effects of risk factors, assets, and the interactional effects mediated by certain factors. They help measure the large effects of risks on outcomes. The latter was based on the characteristics of resilience as related to individuals [31, 32].
Garmezy et al. also proposed three resilience models including compensating, protecting, and challenging models which, respectively, emphasized the inclusion of a compensatory factor for the risk factors, a protective factor to reduce the adverse effects, and contextual adaptation to develop individual skills [33]. Rutter also proposed a model in which protective factors interact with a risk factor, and it is possible to predict adverse effects from these interactions. This researcher also proposed immunizing and strengthening as another model of resilience [34]. Research has also shown that certain effective factors modify, moderate, or reduce an individual’s response to hazardous conditions leading to maladaptive side effects. There are also protective factors interacting with the risk to modify predictive relationships between risk factors, change adverse effects, and lower the chances of adverse effects [35].
Other models have been also proposed for resilience [36-38], all illustrating how individual and contextual factors affect the reduction or omission of the harmful effects of risk factors. Regardless of religious or non-religious and psychological perspectives, none of these models approached the highly interconnected network of the constituent components of resilience from a dynamic perspective. These differences do not by any means imply that contextual and external factors do not affect resilience. From the religious point of view, in the piety sub-system, social relations were mentioned as a key factor in developing and strengthening resilience. As mentioned earlier, from a religious point of view, the main stimulus for using contextual sources effectively to develop and internalize resilience lies within us. It should be approached from a divine perspective to be actualized. In other words, resilience is a multifaceted cognitive construct developed under the influence of other internal personal capabilities, social skills, and also in interaction with the surrounding environment. It is eventually manifested as a positive personality trait. Overall, resilience can be described as a dynamic process in which contextual factors and personality traits interact with each other dynamically and with religious factors to help an individual accept contextual factors logically in interaction with internal factors. Therefore, it seems that in the Islamic lifestyle, to approach individual resilience, we need an Islamic view of the theoretical models of human growth that leads to our moral excellence and growth as the main basis of resilience in life difficulties. These models have been formerly proposed by prominent scholars, such as Erickson, Brunfen, Piaget, Kahlberg, Gillian, Skinner, Maslow, and Pierce [39]. In all these theoretical models, the underlying assumption is that human beings have an inborn mechanism for growth and perfection which can reveal itself under certain contextual conditions. However, in the religious perspective on resilience, the emphasis is on a well-coordinated and comprehensive development and attention to different dimensions of human growth that are psychological, social, cognitive, moral, and spiritual. It seems that all the existing studies have one feature in common with the Islamic approach to resilience, and that is the possibility of promoting individual capabilities. This promotion should aim to create a sense of individual identity and efficiency. It should improve decision-making, goal-setting, and hope for the future. Thus, it can meet human’s primary need for affection, communication with others, challenge, power, and meaning-making in demanding conditions at the core of all educational, preventive, and personal growth interventions [40]. So far, none of the research evidence of resilience has adopted a dynamic systems approach to resilience.
Conclusion
Based on the simple and qualitative review of existing evidence, individuals can become resilient to hardships in life if they follow Islamic rules and regulations and live a purposeful life. They will see problems in life as a divine test that can be tolerated. Such a belief can help human beings to get through the critical conditions of life and tolerate them easily. This is at the core of the meaning of resilience from a religious point of view. Therefore, for individual resilience reinforcement, it is necessary to pay serious attention to creating and strengthening the resilience subsystems mentioned in previous sections.
Study limitations
The main limitation of this study was that literature reviews lack precision and replicability and can present their findings in the context of what has come before and do not attempt to control for the author’s bias. Accordingly, the model was just proposed conceptually through a qualitative study and it was not operationally tested, which is suggested to future researchers.
Future study suggestions
It is suggested that researchers adopt a dynamic systems approach to explore resilience and hope to teach it practically to the population at large. The model needs to be quantitively analyzed too to substantiate its validity. The simulation and scenario analysis should follow as well to be able to apply the model in the real world and judge its effectiveness.
Ethical Considerations
Compliance with ethical guidelines
There were no ethical considerations to be considered in this research.
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflict of interest.
Acknowledgments
We thank all colleagues as well as reviewers for assistance with methodology consultant and comments that greatly improved the manuscript. Also the authors of the valuable resources that we have used are appreciated.