Bloodied but unbowed: resilience examined in a South asian community

Resilience revisited: AIDS and resilience among a Yi ethnic minority in Southwest China

This study attempts to widen the conceptual space of resilience in (Western) psychology in order to better capture the resilience landscape of an ethnic minority group ravaged by the HIV/AIDS pandemic—the Nuosu-Yi in Southwest China. Without decolonizing the construct of resilience, non-Western versions of coping with adversities cannot be properly understood. Our process of decolonization of resilience involved two steps: First, we conducted semistructured interviews with the target population ( N = 21) to take inventory of their Indigenous notions of resilience. Second, for conceptual comparison, we mapped the themes and categories, derived from thematic analysis, of the interview data onto the conceptual space of the Resilience Scale for Adults (RSA), which we used as proxy for mainstream conceptualizations of resilience. This mapping revealed multiple lacunae in the theoretical framework of RSA, and unique properties in the Indigenous approach to adversities in contrast. Far reaching theoretical and practical implications of this investigation are discussed.

Mental health, normativity, and local knowledge in global perspective

Approaching mental health on a global scale with particular reference to low- and mid-income countries raises issues concerning the disregard of the local context and values and the imposition of values characteristic of the Global North. Seeking a philosophical viewpoint to surmount these problems, the present paper argues for a value-laden framework for psychiatry with the specific incorporation of value pluralism, particularly in relation to the Global South context, while also emphasizing personal values such as the choice of treatment. In sketching out this framework, the paper aims to overcome the clash between universalism and relativism about psychiatric categories by focusing on how overlaps between cultures can contribute to ontology-building. A case study analyzing ethnopsychiatric research in the context of South India will illustrate the proposed view, while also pointing out avenues for further research on the causal efficacy of local shared beliefs about mental disorder. If approaches across different traditions and theoretical frames are shown to work in treating similar ailments, causal connections appear to cut across the different ontologies. Ethnopsychiatry would play a central role in such research, namely in disclosing the variables and mechanisms at work within the local approaches.

Resilience and associative stigma among mental health professionals in a tertiary psychiatric hospital: a cross-sectional study in Singapore

OBJECTIVES

The mental health profession exposes healthcare workers to unique stressors such as associative stigma (stigmatisation that is extended from the stigmatised patients to psychiatric professionals and is based on affiliation with an individual with mental illness). Enhancing resilience, or the ability to 'bounce back' from adversity, is found to be useful in reducing occupational stress and its negative effects. In view of the high burnout rates reported among mental health professionals, this study aimed to examine resilience in this group of professionals and to explore the association between resilience and associative stigma.

DESIGN

Observational study-cross-sectional design.

SETTING

Tertiary psychiatry hospital in Singapore.

PARTICIPANTS

The study was conducted among 470 mental health professionals (doctors, nurses and allied health professionals) working in the hospital.

MEASURES

Resilience was assessed using the Brief Resilience Scale (BRS) and participants completed questionnaires that examined associative stigma. Participants provided their sociodemographic information, length of service, and information on whether they knew of a close friend or family member who had a mental illness.

RESULTS

Mean resilience score for the overall sample was 3.59 (SD=0.64). Older age (β=0.012, 95% CI 0.004 to 0.019, p=0.003) and having known a family member or close friend with a mental illness (β=0.155, 95% CI 0.019 to 0.290, p=0.025) predicted higher BRS score. Associative stigma remained significantly associated with resilience score after controlling for sociodemographic factors whereby higher associative stigma predicted lower resilience scores.

CONCLUSION

The present finding suggests that resilience building programmes among mental health workers should target those of the younger age group, and that addressing the issue of associative stigma is essential.

Ambivalence towards discourse of disaster resilience

This paper investigates empirically how the international aid community (IAC)-donors and practitioners-considers and implements disaster resilience in a specific country setting, Nepal, and throughout the rest of the world. A key finding is that there is ambivalence about a concept that has become a discourse. On a global level, the IAC utilises the discourse of resilience in a cautiously positive manner as a bridging concept. On a national level, it is being used to influence the Government of Nepal, as well as serving as an operational tool of donors. The mythical resilient urban community is fashioned in the IAC's imaginary; understanding how people create communities and what type of linkages with government urban residents desire to develop their resilience strategies is missing, though, from the discussion. Disaster resilience can be viewed as another grand plan to enhance the lives of people. Yet, regrettably, an explicit focus on individuals and their communities is lost in the process.

Centering at the Margins: Critical Community Resilience Praxis

Aims: This article aims to reframe resilience for use in community research and action in conditions of adversity marked by increasing natural disasters and by social inequities rooted in the coloniality of power, such as in Chile. Method: We review international resilience literature that explores responses to complex adversities, evaluating three “waves” of resilience research, including (1) “bouncing back,” which frames resilience as protecting functioning; (2) “bouncing forward,” understanding resilience as adaptation; and (3) what we are calling, the “centering at the margins” wave, which explicitly incorporates liberation psychology and decolonial, critical race theories to the study and promotion of resilience. Results: Building off “third wave” thinking, this article attempts to improve the social justice ethics within which research on resilience is completed by introducing a critical community resilience praxis. Conclusions: Critical community resilience praxis can aid the study of resilience by illuminating ways to avoid the reinforcement of social hierarchies and interlocking systems of oppression relevant to the work of disaster risk reduction investigators, psychologists, and differently positioned stakeholders engaged in resilience research and practice in complex settings internationally marked by histories of colonialism, consequences of climate change, and continual social inequities.

Barriers to recovery in communities exposed to disasters: Sri Lankan voices speak

Disasters experienced by a community place all members at risk for physical and psychological harm. While natural resilience may help many to recover, there may be barriers that hinder the recovery process. This qualitative study was conducted to examine barriers to recovery in a community impacted by both war and the tsunami. A group of 43 ethnically diverse Sri Lankans (F = 63%) participated in six focus groups and provided their perspectives on barriers they perceived to impede their recovery from traumatic events. Grounded-theory-based data analysis revealed culture-general and culture-specific socio-economic, environmental, sociocultural, and individual barriers that participants identified as impeding their recovery. Interventions and health policies targeting these groups could focus on helping communities to overcome these barriers as a means of facilitating recovery in these beleaguered communities.

Poles apart: does the export of mental health expertise from the Global North to the Global South represent a neutral relocation of knowledge and practice?

The World Health Organization's Mental Health Action Plan 2013-2020 identifies actions for all member states to alleviate the global burden of mental ill health, including an obligation for mental healthcare to be delivered in a 'culturally appropriate' manner. In this article we argue that such a requirement is problematic, not least because such pronouncements remain framed by the normative prepositions of Western medical and psychological practice and their associated ethical, legal and institutional standpoints. As such, when striving to export Western mental health expertise, different paradigms for evidence will be necessary to deliver locally meaningful interventions to low and middle income countries. Our discussion highlights a number of philosophical concerns regarding methodologies for future research practice, including those relating to representation and exclusion in the guise of epistemic injury, presumptive methodologies arising from Western notions of selfhood, and related ethical issues.

A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants

BACKGROUND

The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. However, resilience, defined as the ability of a person to successfully adapt to or recover from stressful and traumatic experiences, has been highlighted as a key potential protective factor. This study aimed to review systematically the global literature on the impact of resilience on the mental health of adult conflict-driven forced migrants.

METHODOLOGY

Both quantitative and qualitative studies that reported resilience and mental health outcomes among forcibly displaced persons (aged 18+) by way of exploring associations, links, pathways and causative mechanisms were included. Fourteen bibliographic databases and seven humanitarian study databases/websites were searched and a four stage screening process was followed.

RESULTS

Twenty three studies were included in the final review. Ten qualitative studies identified highlighted family and community cohesion, family and community support, individual personal qualities, collective identity, supportive primary relationships and religion. Thirteen quantitative studies were identified, but only two attempted to link resilience with mental disorders, and three used a specific resilience measure. Over-reliance on cross-sectional designs was noted. Resilience was generally shown to be associated with better mental health in displaced populations, but the evidence on this and underlying mechanisms was limited.

DISCUSSION

The review highlights the need for more epidemiological and qualitative evidence on resilience in forcibly displaced persons as a potential avenue for intervention development, particularly in resource-poor settings.

An argument against the focus on community resilience in public health

Background

It has been suggested that Public Health professionals focus on community resilience in tackling chronic problems, such as poverty and deprivation; is this approach useful?

Discussion

Resilience is always i) of something ii) to something iii) to an endpoint, as in i) a rubber ball, ii) to a blunt force, iii) to its original shape. “Community resilience” might be: of a neighbourhood, to a flu pandemic, with the endpoint, to return to normality. In these two examples, the endpoint is as-you-were. This is unsuitable for some examples of resilience. A child that is resilient to an abusive upbringing has an endpoint of living a happy life despite that upbringing: this is an as-you-should-be endpoint. Similarly, a chronically deprived community cannot have the endpoint of returning to chronic deprivation: so what is its endpoint? Roughly, it is an as-you-should-be endpoint: to provide an environment for inhabitants to live well. Thus resilient communities will be those that do this in the face of challenges. How can they be identified?

One method uses statistical outliers, neighbourhoods that do better than would be expected on a range of outcomes given a range of stressors. This method tells us that a neighbourhood is resilient but not why it is. In response, a number of researchers have attributed characteristics to resilient communities; however, these generally fail to distinguish characteristics of a good community from those of a resilient one. Making this distinction is difficult and we have not seen it successfully done; more importantly, it is arguably unnecessary.

There already exist approaches in Public Health to assessing and developing communities faced with chronic problems, typically tied to notions such as Social Capital. Community resilience to chronic problems, if it makes sense at all, is likely to be a property that emerges from the various assets in a community such as human capital, built capital and natural capital.

Summary

Public Health professionals working with deprived neighbourhoods would be better to focus on what neighbourhoods have or could develop as social capital for living well, rather than on the vague and tangential notion of community resilience.