Medimond - Monduzzi Editore International Proceedings Division
The Second World Congress on Resilience:
From Person to Society May 8-10, 2014 - Timisoara (Romania) Editor
Serban Ionescu Associate Editors
Mihaela Tomita, Sorin Cace
MEDIMOND
International Proceedings
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Foreword The first and crucial observations leading to understanding the concept of resilience were made on children experiencing chronic adversity. Afterwards, research on resilience expanded to adults and the elderly, included longitudinal studies, and was tackled using a lifespan approach. At the same time, resilience was studied in increasingly diversified situations, belonging both to the registers of traumatic events and of chronic adversity. Though initial studies focussed on individual resilience and on facilitating personal characteristics, it very quickly became clear that many factors pertaining to the family and to the general environment are involved in the process underlying the development of resilience. In parallel, it became obvious that families, communities and societies living in chronic adversity or experiencing traumatic events can be resilient. Thus have been established the fields of family, community and, more recently, societal resilience. The rapid expansion of the use of the resilience concept is not without generating many questions. Is this extension risky? Does it contribute to the trivialization, to the dilution of the concept of resilience? Or does it testify of its development, its richness, and heuristic value? What are the consequences on the theory of resilience? What are the implications for practice? By bringing together practitioners and researchers working on individual resilience (discussed in a life cycle perspective), on family, community and societal resilience, the Second World Congress aimed to provide answers to these questions and to advance our knowledge in the field. The four conferences, the five roundtables in plenary sessions, and the 256 papers presented during the 27 thematic sessions that took place during the Congress will certainly help to the advancement of knowledge in the field. The diversity of information makes necessary, in the near future, an important effort towards synthesis. To join all the scientific community in this discussion, the organizers have decided to publish this e-book gathering together all the papers presented in thematic sessions. The plenary presentations will be published later. In this way, we hope that the Congress held in Rumania will contribute to the progress of the current stage in the evolution of resilience research – designated as the fourth wave – a stage characterized by multileveled and multidisciplinary analysis of the ways in which resilience is shaped. Serban Ionescu
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International Scientific Committee - Şerban Ionescu – Chairman (Paris, France ; Trois-Rivières, Canada) Members: - Mircea Lazarescu (Timisoara, Romania) - Joaquina Palomar Lever (Mexico City) - Joëlle Lighezzolo-Alnot (Nancy, France) - Driss Moussaoui (Casablanca, Morocco) - Ana Muntean (Timisoara, Romania) - Nathalie Nader-Grosbois (Leuven, Belgium) - Mohamed-Nadjib Nini (Constantine, Algeria) - Alicia Omar (Rosario, Argentina) - Jean-Pierre Pourtois (Mons, Belgium) - Ovidiu Predescu (Bucuresti, Romania) - Maria Roth (Cluj, Romania) - Eugène Rutembesa (Butare, Rwanda) - Mihaela Tomita (Timisoara, Romania) - Michel Tousignant (Montreal, Canada) - Nicoleta Turliuc (Iasi, Romania) - Adrian D. Van Breda (Johannesburg, South Africa) - Diana Vasile (Bucuresti, Romania) - Valentina Vasile (Bucuresti, Romania)
- Guido Alessandri (Rome, Italy) - Lena Alex (Umea, Sweden) - Pedro Amoros Marti (Barcelona, Spain) - Marie Anaut (Lyon, France) - Michel Born (Liege, Belgium) - Evelyne Bouteyre (Aix-Marseille, France) - Renata Maria Coimbra Liborio (Presidente Prudente, Brazil) - Ştefan Cojocaru (Iaşi, Romania) - Boris Cyrulnik (Toulon, France) - Dmitry M. Davydov (Moscow, Russia) - Amrita Deb (Hyderabad, India) - Michel Delage (Toulon, France) - Keren Friedman Peleg (Tel Aviv, Israel) - Myrna Gannagé (Beirut, Lebanon) - Odin Hjemdal (Trondheim, Norway) - Colette Jourdan-Ionescu (Trois-Rivières, Canada) - Yvonne Kayiteshonga (Kigali, Rwanda) - Fionna Klasen (Hamburg, Germany) - Joseph T. F. Lau (Hong Kong, China)
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National Organizing Committee - Marilen Pirtea University of the West Timisoara – Rector - Mircea Lazarescu (Timisoara) - Florin Tudose (Bucharest) - Catalina Tudose (Bucharest) - Nicoleta Turliuc (Iasi) - Ştefan Cojocaru (Iasi) - Mircea Dutu (Bucharest)
- Ovidiu Predescu (Bucharest) - Felicia Iftene (Cluj) - Doina Cosman (Cluj) - Valentina Vasile (Bucharest) - Constantin Duvac (Bucharest) - Simona Stanescu (Bucharest)
Local Organizing Committee (Timisoara) - Carmen Băbăită - Alin Gavreliuc - Lucian Bercea - Ovidiu Megan - Marinel Iordan - Mariana Crasovan - Melinda Dincă - Cosmin Goian - Alin Sava - Flavia Barna - Loreni Baciu - Andreea Birneanu - Iuliana Costea - Ioana Dârjan - Corina Ilin
- Andreea Ionescu - Anda Jurma - Theofild Lazăr - Ana Muntean - Anca Munteanu - Violeta Stan - Alexandra Stancu - Mihai Predescu - Laurentiu Tîru - Loredana Trancă - Marius Vasiluta - Gabriela Zărie - Alina Zamostean - Mihaela Tomita-coordinator
Congress secretariat - Diana Dragomir - Spria Bianu - Ioana Truşcă
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Plenary sessions Key Speakers Sir Michael Rutter Serban Ionescu Ann Masten Boris Cyrulnik
Participants to round tables Aguerre Colette (France) Anaut Marie (France) Balaceanu-Stolnici Constantin (Roumanie) Born Michel (Belgique) Bouteyre Evelyne (France) Cojocaru Stefan (Roumanie) Duriez Nathalie (France) Jébrak Yona (Canada) Jourdan-Ionescu Colette (Canada) Lighezzolo-Alnot Joëlle (France) Lynch Marina A. (Irlande) Michallet Bernard (Canada) Moisseeff Marika (France) Nowlan Kate (Royaume-Uni) Pessoa Alex (Brésil) Pishva Ehsan (Pays-Bas) Predescu Ovidiu (Roumanie) Tomita Mihaela (Roumanie) Tousignant Michel (Canada) Turliuc Nicoleta (Roumanie) Van Breda Adrian D. (Afrique du Sud) Vasile Valentina (Roumanie)
Chairs of Plenary sessions Ionescu Serban (Canada-France-Roumanie) Muntean Ana (Roumanie) Van Breda Adrian D. (Afrique du Sud) Labelle Réal (Canada) Hjemdal Odin (Norvège) Rutter Michael (Grande-Bretagne) Friedman-Peleg Keren (Israël) Lazarescu Mircea (Roumanie) Nader-Grosbois Nathalie (Belgique)
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Contents Session I. Resilience as Individual Feature, Outcome and Process
The Mourning and Resilience of People who have Suffered Significant Losses Costin A. .............................................................................................................................................................
1
The Experience of Resilience in People Recovered from Bipolar Disorder Echezarraga A., Las Hayas C., González-Pinto A.M., López M.P., Luis P., Echeveste M........................
5
Identifying Protective Factors in adults – a systematic review to inform Resilience-Building Programs Höfler M...............................................................................................................................................................
11
Vocational recovery in first-episode psychosis Ienciu M., Romosan F., Bredicean C., Cristanovici M., Hurmuz M. ............................................................
19
The inanimate object as a protective factor in the process of resilience Ionescu S., Boucon V........................................................................................................................................
23
Impact of personality spiritual dimensions on quality of life and resilience Manea Minodora M., Cosman Doina M.C., Lazărescu Mircea D. ................................................................
27
The symptom as resilience Robin D. ..............................................................................................................................................................
31
The role of psychological flexibility for resilience and psychological health Théorêt M., Durand J.C., Sénéchal C., Savoie A., Brunet L., Poirel E., St-Germain M.............................
35
Session II. Resilience and Coping Mechanisms
The Resilience-Oriented Therapeutic Model: A Preliminary Study On Its Effectiveness In Italian Polyabusers Bonfigli Natale S., Renati R., Farneti P.M.......................................................................................................
41
Resilience in Oncology Patients: The role of coping mechanisms Bredicean C., Papava I., Pirvulescu A., Giurgi-Oncu C., Ile L., Popescu A., Hurmuz M..........................
47
Resilience, coping strategies and metabolic control in adolescents with type 1 diabetes Cosma A., Băban A. ..........................................................................................................................................
51
Resilience and coping in sexually abused teenage girls Dubuc L...............................................................................................................................................................
55
Coping and survival strategies during repression – the romanian former political prisoners’ experience Macarie G.F., Doru C., Voichita T.A.................................................................................................................
59
Stress, coping and quality of life of Belgian parents of children with autism sepctrum disorder Nader-Grosbois N., Cappe E............................................................................................................................ © Medimond
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63
Critical discourses on resilience: Exploring alternatives strategies used by young people at-risk Gomes Pessoa A.S., Coimbra Libório R.M., Bottrell D. ...............................................................................
69
Session III. Resilience of the Child and Adolescent
Exposure to adverse childhood experiences and health problems in adulthood: the role of family related protective factors Baban A., Cosma A., Balazsi R........................................................................................................................
73
Bullying victimization in childhood: which factors act as buffer for health problems in adulthood? Cosma A., Baban A., Balazsi R........................................................................................................................
79
Risk factors and resilience in the offspring of psychotic parents Nussbaum L., Papava I., Nussbaum L., Vucea F., Fiţiu B., Micu-Serbu I. B., Filimon E..........................
85
Explanatory variables of resilience in latin american youngsters Omar A. ...............................................................................................................................................................
91
What resilience has to say about bullying Sánchez J. ..........................................................................................................................................................
97
The impact of cumulative risk on adolescents: how it acts on different outcomes and which assets can moderate it Simões C., Gaspar De Matos M., Lebre Melo P., Antunes M....................................................................... 101 Session IV. Resilience of the Child in Foster Home or Institutionalized
Break rules behavior problems of children in long term foster care: a profile using the child behavior checklist 6-18 Birneanu A.......................................................................................................................................................... 107
The significance figures in the foster care system as a source of resilience for adolescents Ciurana A., Pastor C., Fuentes-Peláez N........................................................................................................ 111
Rpm-android: a tablet application to cooperate with vulnerable families Fantozzi C., Ius M., Serbati S., Zanon O., Milani P. ....................................................................................... 115
The kinship fostered youth: a program to promote resilience Fuentes-Peláez N., Pastor C., Balsells M.A., Amorós P., Mateo M............................................................. 121
P.I.P.P.I. program of intervention for prevention of institutionalization. Participatory strategies to prevent child placement Ius M., Serbati S., Di Masi D., Zanon O., Milani P.......................................................................................... 127
Strategies to strengthen resilience for children in the child protection system Pastor C., Vaquero E., Fuentes-Peláez N., Urrea A., Ciurana A., Navajas A., Ponce C. .......................... 133 Session V. Adoption and Resilience
Adoptive life trajectory: What resiliences face to the original breakdown? Vinay A................................................................................................................................................................ 137
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Motherless child resilience: Psychosocial aspects Bouzeriba-Zettota R., Kouadria A. .................................................................................................................. 143
Peculiarities of value systems of candidate adoptive parents Kashirsky D., Sabelnikova N............................................................................................................................ 149
Resilient lives and autobiographical suggestions italian national training process in the field of intercountry adoption Macario G............................................................................................................................................................ 153
Early deprivation and behavioural adaptation in a sample of italian adopted adolescents Molina P., Casonato M., Ongari B., Decarli A. ............................................................................................... 159
The resilience of adopted children in Romania Muntean A., Ungureanu R., Tomita M............................................................................................................. 165
Mother’s image of her adopted child and peculiarities of attachment relationships in adoptive family Sabelnikova N., Kashirsky D............................................................................................................................ 169 Session VI. Parent - Child Interactions, Attachment and Resilience
Building resilience in mother-child residential centers: risk and protective factors Arace A., Scarzello D......................................................................................................................................... 173
The social construction of breastfeeding in public: an incursion into the discussion forums Cristescu Delia S., Petruţ Paula A., Tăut D. ................................................................................................... 179
The flawed mother-son psychological union as non-resilience to manhood challenges Cruceanu Roxana D. ......................................................................................................................................... 185
Cognitive resilience factors for parental distress in the case of parents having children with externalizing disorders David Oana A. .................................................................................................................................................... 191
Sociodemographic and obstetrical risk factors in mothers with postnatal depression from timiș county. A preliminary survey Enătescu Virgil R., Enătescu I., Enătescu V. ................................................................................................. 195
A qualitative evaluation of a theory-based support group intervention for children affected by maternal HIV/AIDS in South Africa Finestone M., Eloff I., Forsyth B. ..................................................................................................................... 201
Listening to the therapeutic alliance in diabetic patients from preventive and therapeutic education poles in Picardy: Clinical research on attachment, coping and resilience Valot L., Wawrzyniak M., Lalau J.-D., Mience Marie C., Lecointe P............................................................ 209
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Session VII. Resilience of Persons in Risk Situations
The correlation between resilience and cognitive schemas among people with psychiatry diagnosed parents Crăciun A. ........................................................................................................................................................... 215
Resilience factors in patients with schizophrenia Dehelean L., Stefan E.-D., Manea M.-O., Papava I., Dehelean P.................................................................. 221
The resilient process and factors from the experience of people recovered from bipolar disorder Echezarraga Porto A., Las Hayas Rodríguez C., González-Pinto Arrillaga A.M., López Peña María P., Pacheco Yañez L., Echeveste Portugal M...................................................................................................... 227
The evolution in response to the call of the moral responsibility for a relative with dementia: Should we be wary of resilience? Éthier S., Boire-Lavigne A.-M., Garon S. ........................................................................................................ 233
Intellectual disability: Protection against trauma? Gwoenaël E......................................................................................................................................................... 239
Beyond repetition. Resilience in obsessive-compulsive disorder – case study Ile L., Pop C., Popa C., Bredicean C., Varga S............................................................................................... 243
The adaptability of persons with muscular dystrophy: from individual to society. Case study - psychosocial impact on the individual Ionescu I., Banu O., Rotaru S........................................................................................................................... 249
Protective factors involved in resilience of institutionalized children after abuse within the family Jurma Anda M., Kanalas G., Mitrulescu Păișeanu A.L., Morariu D., Tocea C., Gheorghiu Lorica G., Mitrofan M., Katarov M...................................................................................................................................... 255
Individual and emotional experiences of the vesos foster children aged 6 to 12 in togo Kalina K., Bouteyre E. ....................................................................................................................................... 261
Resilience study in the case of father-daughter, father-in-low – daughter-in-low incest in prepubertal and pubertal period Lapointe D., Le Bossé Y. .................................................................................................................................. 265
Early sexual abuse, access to maternity, baby’s gender and resilience Lighezzolo-Alnot J., Laurent M........................................................................................................................ 273
Resilience, a constituent for a better life of persons with psychotic troubles in the agora of social reality? Popp Lavinia E., Andrioni F., Chipea Lavinia O. ........................................................................................... 277
Are resilience questionnaires capable of predicting burnout risk? Portzky M. ........................................................................................................................................................... 281
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Institutional resilience of social economy entities: Rethinking social profit in Romania Stănescu S.M., Cace S., Nemțanu M............................................................................................................... 285
Alexithymia and resilience in women with depressive disorders Tepei A. ............................................................................................................................................................... 289
Children rare chronic illnesses and family resilience Villani M., Montel S., Bungener C.................................................................................................................... 295
Resilience in living with an (acquired) physical disability Vrabete A., Băban A. ......................................................................................................................................... 301
Extreme situations, family relationships and resilience: Report from longitudinal follow-up of polar wintering and their families Wawrzyniak M., Solignac A., Schmit G., Lefebvre F..................................................................................... 305 Session VIII. Education, School Environment and Resilience
The resilience and the development of the human resources from education Andone L. ........................................................................................................................................................... 309
Knitting-weaving resilience: Development of mnemonic resilient self-tutorant processes in a destroyed being Boulard F. ........................................................................................................................................................... 313
Recognize resilient children: A survey of 90 kindergarten and elementary schools teachers - preliminary results Bouteyre E., Sanchez-Giacobbi S., Lauch-Lutz M. ....................................................................................... 317
Academic resilience and academic adjustment for the first year university students Cazan A.-M.......................................................................................................................................................... 321
The need for mentoring as a resilience factor for adapting to school workplace Crasovan M., Predescu M................................................................................................................................. 327
Specific and efficient in the strategy to increase resilience in university environment Danciu E.L. ......................................................................................................................................................... 333
Analysis of a relationship between the educational well-being and resilience in teachers from secondary schools Dobrica-Tudor V., Théorêt M............................................................................................................................ 337
Six or seven: when is a child resilient enough to start school and to cope with the transition stress? Czech and polish experience: social policy and research outcomes Hoskovcová S., Sikorska Iwona M.................................................................................................................. 343
The bullying phenomenon: victims point of view Lazăr T.-A............................................................................................................................................................ 347
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School attendance of Dominican students after primary education. Family dynamics and resilience Madariaga J.-M., Plourde S., Arribillaga A. .................................................................................................... 353
The issue of resilience in the context of small age children education Stan L. ................................................................................................................................................................. 357
A teaching model for preventing the educational failure at university level Țîru C.M............................................................................................................................................................... 363
For a more rooted resilience, a broader view of self Zacharyas C., Théorêt M., Brunet L., Savoie A., Boudrias J.-S................................................................... 369 Session IX. Resilience of the Elderly
The elderly - a person that needs more attention Breaz M.A............................................................................................................................................................ 375
A strategic approach based on resilience Casula C.C. ......................................................................................................................................................... 379
Resilience of women and elders survivors of domestic violence Dinu A.I................................................................................................................................................................ 383
Resilient components in group geronto-psychotherapy. A case study Draghici R. .......................................................................................................................................................... 387
The older Womenresilience Gal D., Rușitoru M. ............................................................................................................................................ 391
Resilience in successful aging Lucăcel R., Băban A.......................................................................................................................................... 395
Loss of life whilst still alive: Improving resilience and attachment with older people and people with dementia through the application of ‘Neuro-Dramatic Play’ Jennings S.......................................................................................................................................................... 401 Session X. Family Resilience, Transgenerational Transmission
Sexual emotional health among vulnerable adolescents Mateos A., Fuentes-Pelaez N., Molina M.C., Amoros P................................................................................ 405
The «Apprender juntos, crecer in familia» program for the development of resilience and positive parenting Amorós P., Balsells M.A., Mateos A., José R.M., Vaquero E....................................................................... 411
The biological family in child protection: A socio-educational program to build resilience in the process of family reunification Balsells M.A., Molina Mari C., Mateos A., Vazquez N., Mundet A., Torralba J.M., Parra B...................... 415
Parental education - a program that builds the resilience of parents from the vulnerable families Clicinschi C., Sfetcu L....................................................................................................................................... 419 © Medimond
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Positive attentional bias as a resilience factor in parenting. Implications for attention bias modification online parenting interventions David Oana A., Podină I.................................................................................................................................... 425
The leisure experience of young people living with a disability and family resilience Duquette M.-M. ................................................................................................................................................... 429
A multidisciplinary care device, family support and resilience in rehabilitation service for back problems Fayada P., Dimitrescu D., Verrecas E., Schauder S., Wawrzyniak M......................................................... 433
The role of social support in the resilience process of a child with Gilles de la Tourette Syndrome (GTS) parents Gousse V., Czernecki V., Stilgenbauer J.-L., Denis P., Deniau E., Hartmann A. ...................................... 439
The family tale, an intergenerational project vector of resilience? Haelewyck M.C., Geurts H., Roland V............................................................................................................. 445
The notion of transmission in the center of parenting of hearing parents of a deaf child with cochlear implant. Is resilience possible? Lovato M.-A., Goussé V. ................................................................................................................................... 451
Parenting and intellectual disabilities: Resilience factors Milot É., Tétreault S., Turcotte D...................................................................................................................... 455
Children’s resilience and family secrets Moldovan V......................................................................................................................................................... 461
Promotion of family resilience in educational and recreational hospital spaces Molina M.C., Pastor C., Ponce C., Casas J., Mundet A., Albert L................................................................ 465
Family leisure as a factor of resilience: How can we improve it within a context of residential care? Youths’ perspectives Navajas Hurtado A., Balsells Bailón M.À. ...................................................................................................... 469
Emotion recognition, family patterns and resilience factors in psychotic patients’ families Popescu A.-L., Papavă I., Hurmuz M., Bredicean C., Ienciu M., Nirestean A. ........................................... 473
Modelling resilience in the family – a systemic perspective Radu I., Răcorean Ș.-I., Gherzan N.................................................................................................................. 479
Explaining risk and protective factors in developing proactive and reactive aggression Saric M. ............................................................................................................................................................... 485
Protective factors in siblings of youths with Trisomy 21 St-André M.-P., Jourdan-Ionescu C., Julien-Gauthier F............................................................................... 491
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Research on protective factors in five resilient women who grew up with a parent suffering from bipolar disorders Tang H., Bouteyre E. ......................................................................................................................................... 497
Child’s behavior, quality of life, and marital adjustment of parents with autistic children: Mediator effect of resilience and social support Turliuc M.N., Duca D.-S..................................................................................................................................... 501
Promoting positive parenting; a strategy to improve family resilience in contexts of social inequalities Vázquez N., Molina M.C., Ramos P., Artazcoz L............................................................................................ 507
Shāh Māt and historic(al) non-resilience: Tolls and victims Zelinka E. ............................................................................................................................................................ 513
The adaptability of needy families to a precarious social state Hirghiduş I., Fulger Ioan V................................................................................................................................ 517 Session XI. Community and Social Resilience
Resilience and social risks management. Concepts and policies Anghel I. .............................................................................................................................................................. 523
Building resilient practices in a sustainable regional development context Borza M., Boutin E., Gâdioi E., Duvernay D................................................................................................... 531
Analysis of a system of cultural resilience in a person experiencing a suicidal crisis in Reunion Island Brandibas J., Ah-Pet M. .................................................................................................................................... 537
Dynamics of social identity. Social distance in multicultural regions Dincă M. .............................................................................................................................................................. 543
Becoming resilient in a professional context: Experimental approach of a labelling context of social visibility Duvernay D., Boutin E., Gâdioi E..................................................................................................................... 549
What is the effect of stressors and resources on the expatriates’ perception of the bidirectional work-family conflict and cross-cultural adjustment? Farcas D., Gonçalves M.................................................................................................................................... 557
The failure of status achievement Fulger Ioan V., Hirghiduşi I............................................................................................................................... 563
Adaptation of the Protective factors scale in the sociocultural context of women in Cameroon Kimessoukie O.É., Jourdan-Ionescu C. ......................................................................................................... 569
Building capacity in public health nursing students to respond to adversity experienced in the reality of practice Lindley P., Hart A............................................................................................................................................... 575
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Social support, satisfaction with physician-patient relationship, couple satisfaction, body satisfaction, optimism as predictors of life satisfaction in people having a current perceived health problem Mincu Cornel L., Avram E................................................................................................................................. 579
The church’s contribution to the resilience of the child institutionalised in Romania in view of his integration into society Petrica I. .............................................................................................................................................................. 587
From the city of education to the resilient city Pourtois J.-P., Desmet H................................................................................................................................... 591
Resistance and resilience in active minority behaviours Stan D.................................................................................................................................................................. 599
Social processes of resilience among young men leaving the care of girls and boys town, South Africa D. Van Breda A................................................................................................................................................... 603 Session XII. Migration, Minorities and Resilience
Social economy for Roma population – intervention strategies for supporting the social integration of Roma ethnics in Romania Cace S., Sfetcu L................................................................................................................................................ 609
The role of family democratization in the adaptation process to circulatory migration Ciortuz A. ............................................................................................................................................................ 613
Risk and resilience: Children’s perspectives through drawings on parent’s economical migration and ethnicity Micu-Șerbu I.B., Gafencu M., Nyiredi A., Bajireanu D., Stehlic R., Stan V.O............................................. 619
Community resilience and social inclusion of people living in rural areas. Development of a win win strategy Stănescu S.M., Vasile V., Bălan M., Petre R.-T. ............................................................................................. 627
The role of the elite Roma population in their community development Zamfir E............................................................................................................................................................... 631
Self-concepts and resilience by Roma youngsters living in poor communities Roth M., Pop F., Raiu S. .................................................................................................................................... 635 Session XIII. Human Trafficking and Domestic Violence
Best practices in the resilience process of the human trafficking victims Askew M.............................................................................................................................................................. 639
Human trafficking victims and the process of resilience Borlea C. ............................................................................................................................................................. 645
The resilience of mother-child couple in domestic violence Dumitrescu A.M. ................................................................................................................................................ 651
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The role of the social work as professional factor in resilience building in the human traffic phenomenon Goian C., Runcan P.L........................................................................................................................................ 655
In the aftermath of family violence: Lifeworlds of resilient adolescents. Are resilient adolescents really over the edge? Kassis W., Artz S. .............................................................................................................................................. 659
Psychological aspects of trauma and resiliency in victims of human trafficking Muntean A........................................................................................................................................................... 663 Session XIV. Resilience and Natural Disasters
Trauma and natural disaster: The impact of attachment to the habitat on the lives of flood victims – qualitative study regarding the flooding of the Somme valley (Picardy, France) – Spring 2001 Agneray F., Tisseron S., Mille C., Wawrzyniak M., Schauder S. ................................................................. 669
Resilience centered approach for children during floods Gafencu M., Tomita M., Dragu M., Bajireanu D., Moron M., Stan V. ........................................................... 677
A study of changes in the impressions of yogo teachers about the condition of school children (aged 6 to 15 years) over a three year period in a prefecture severely affected by the tsunami of March 2011 in Japan Kamiyama M., Nakatani K., Sato M. ................................................................................................................ 681
Trauma and resilience in 3 to 6 years old children in three neighborhoods of Port-au-Prince, after the 2010 earthquake Mouchenik Y., Derivois D. ................................................................................................................................ 685 Session XV. Resilience and Traumatic Memory, after Totalitarian Regime, War, Genocide, Traumatized Societies
The bread of the dead people, words of ghosts: Stories of resilience in the concentration camps Benestroff C. ...................................................................................................................................................... 689
Resilient communities, historical trauma and narrative reconstruction of identity Gavreliuc A......................................................................................................................................................... 695
Risk and protection in mental health among Syrian children displaced in Lebanon Giordano F., Boerchi D., Hurtubia V., Maragel M., Koteit W., Yazbek L., Castelli C................................. 703
Resilience throughout life: The narrative of a senior missionary kidnapped by Renamo Gonçalves M....................................................................................................................................................... 713
Conceptualizing resilience: Dissociation, avoidance, and silence as resilient trajectories among former child soldiers and ex-combatants coping with past trauma and present challenges in acholiland, Northern Uganda Harnisch H., Knoop Hans H., Montgomery E. ............................................................................................... 717
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Resilience and segregation on post-communist romanian labour market Istrate M., Bănică A. .......................................................................................................................................... 729
Resilience in children originated from families in which parents migrate due to labor conditions Kanalas G., Micu-Serbu I.B., Gulyas V., Ranta M., Nussbaum L., Nyiredi A., Jurma A., Rozinbaum G.I.................................................................................................................................................... 735
The resilience of the second generation following the communism Muntean A., Ungureanu R. ............................................................................................................................... 741
Resilience and personality. Orientation to failure as personality trait of Romanian people viewed from a historical perspective Nedelcea C., Ciorbea I., Ciorbea V., Iliescu D., Minulescu M....................................................................... 747
Alice, the survivor Paries C., Mandart J.-C., Le Doujet D.............................................................................................................. 753
The resilience manifestation in Reunion Island traditional environment Payet Sinaman F................................................................................................................................................ 757
Narrative constructs of resilience in post-apartheid South Africa Rogobete I., Rogobete S................................................................................................................................... 761 Session XVI. Organizational and Professional Environment Resilience
Organizational resilience in the mining industry within the Valea Jiului communities Anghel M.E., Ştefănescu Marius V.................................................................................................................. 767
From independence to strength: Institutional resilience and coping mechanisms in NGOs providing social services financed through public financing mechanisms Baciu L. ............................................................................................................................................................... 773
Resilience in humanitarian aid workers: Understanding processes of development Comoretto A. ...................................................................................................................................................... 779
Helping professionals - the bless and the burden of helping Dârjan I., Tomita M............................................................................................................................................. 787
The professional quality of life in resident psychiatrists Dragu C., Macsinga I., Dragu C., Papavă I., Tirintica R., Iuga G.................................................................. 791
Towards an ecologically based intervention to grow professional resilience Hudson C., Hart A., Dodds P............................................................................................................................ 797
Resilience and public administration: Implications for the “New Political Governance” in Canada Milley P., Jiwani F. ............................................................................................................................................. 803
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Organizational resilience and commitment to workplace Pavalache-Ilie M., Rioux L. ............................................................................................................................... 809
From empathy to compassion fatigue. How can health care practitioners develop resilience and keep their positive engagement? Ruysschaert N.................................................................................................................................................... 815
Personal growth in the context of exposure to trauma life events Turliuc M.N., Măirean C..................................................................................................................................... 819
Psychological capital and well being: The role of psychological detachment Vîrgă D., Paveloni A........................................................................................................................................... 825 Session XVII. Resilience and Justice, Delinqunecy
Over-indebtedness: Consumer bankruptcy as a means of rehabilitating debtors Bercea L.............................................................................................................................................................. 831
Legal culturalism as resilience Bercea R.............................................................................................................................................................. 837
Romanian restorative justice – does it really work? Ciopec F., Roibu M. ........................................................................................................................................... 843
Role of self-esteem in improving the resilience of delinquent youth Dragomir D.L. ..................................................................................................................................................... 847
Execution of non-custodial guidance and supervision orders Fanu-Moca A., Roșu C. ..................................................................................................................................... 851
Mediation – a premise of promoting assisted resilience for both victim and offender Fiscuci I.C. .......................................................................................................................................................... 855
The adjustment of the contract by rebalancing benefits – a way of overcoming the over-indebtedness the parties of an agreement Mangu Codruţa E., Mangu Florin I. ................................................................................................................. 859
Mediation - an instrument for assisted resilience in mobbing cases Marin Ioana A. .................................................................................................................................................... 863
Interdisciplinarity as resilience in legal education Mercescu A......................................................................................................................................................... 869
The Rescinding of European Institutions related to Human Rights Issue Micu G. ................................................................................................................................................................ 873
The educational measures in the new penal code, model of social resilience in the juvenile criminal policy Paşca I.-C............................................................................................................................................................ 877
Reflections upon the resilience of women inmate Poledna S............................................................................................................................................................ 883
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Resilience in children subject to parents’ divorce trauma. Searching for references in jurisprudence Popa F. ................................................................................................................................................................ 891
Cross-border insolvency in the new insolvency code of Romania Popovici S........................................................................................................................................................... 895
Resilience-victimology-criminal justice Predescu O., Tomiţă M...................................................................................................................................... 899
The over-indebtedness of the states, companies and population Sandor F.............................................................................................................................................................. 903
The risk of default and credit insurance Sferdian I............................................................................................................................................................. 909
Resilience and criminality Stan George L. ................................................................................................................................................... 913
The sentencing system of criminally responsible juveniles. Between resilience and resistance Stănilă L.M. ......................................................................................................................................................... 917
Wouldn’t it be a shame to waste a good crisis? The role CSR could play Stârc-Meclejan F. ............................................................................................................................................... 921
Resilience and relapse into crime Sumănaru L. ....................................................................................................................................................... 927
Philosophy of mediation Sustac Z.D. ......................................................................................................................................................... 933
Children’s rights as a mechanism to promote resilience. Socio-educational program based on the rights approach Urrea Monclús A. ............................................................................................................................................... 937
The new concept of judicial emotional resilience Vlădoiu N............................................................................................................................................................. 941 Session XVIII. Economic Resilience
Disabled person’s tourism – a component of social tourism Babaita C............................................................................................................................................................. 945
Business resilience and the merger and acquisition activity Barna F.-M., Nachescu M.-L. ............................................................................................................................ 949
Resilience analysis in people affected by unemployment Călăuz Adriana F................................................................................................................................................ 955
Resilience at work Cameron J., Hart A., Sadlo G. .......................................................................................................................... 961
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Economic resilience to disturbing forces Ciote C................................................................................................................................................................. 967
Hypostases of resilience for sustainable development Constantinescu A. ............................................................................................................................................. 971
Emigration – Romanians’ form of resilience to the dysfunctionalities of the labour market Horea-ŞerbanR.-I. .............................................................................................................................................. 977
Sparks of modeling resilient socioeconomic systems Oneaşcă I. ........................................................................................................................................................... 981
The WEEE management in Romania in the context of economic resilience Popescu M.-L. .................................................................................................................................................... 985
Professional judgment of the financial analyst in the context of normative and positive theories of accounting directed by the economic resilience Stefan-Duicu Viorica M., Stefan-Duicu A........................................................................................................ 989 Session XIX. Mass-Media, Internet, Social Networks and Resilience
ResilienTIC meet on Internet: Digital rituals and resilience Amato S., Boutin E., Duvernay D. ................................................................................................................... 995
Resilience and Internet ecosystem Boutin E., Amato S., Gadioi E. ......................................................................................................................... 1003
The boosting effect of social networking on resilient processes Marzouki Y., Bouteyre E. .................................................................................................................................. 1009
Digital literacy and resilience: Correlational and comparative study among two groups of adolescents Vaquero Eduard T.............................................................................................................................................. 1013
On the temperaments and personalities in the Post-PC era Voicu M.-C., Gergely T.-T., Popa A.-C............................................................................................................. 1017 Session XX. Methodological Issues: Cross Sectional and Longitudinal Research, Case Studies and Appreciative Survey
Using appreciative inquiry in social interventions and develop resilience in the context of chronic adversity Cojocaru S. ......................................................................................................................................................... 1023
Narrative and resilience forms Lani-Bayle M....................................................................................................................................................... 1027
Study on the remigration of Romanian children: 2008-2012. Quantitative and qualitative aspects Luca C., Gulei A.-S., Foca L. ............................................................................................................................ 1033
The role of family and school in self identity formation of teenagers Lungu M. ............................................................................................................................................................. 1043 © Medimond
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Consideration about objective measurement in the study of the individual resilience Mateas M., Gheorghiu I..................................................................................................................................... 1049
A case study of applying Q-methodology to investigate the meaning of resilience Predescu M., Dârjan I., Tomiţă M..................................................................................................................... 1055
Risk factors and protective factors in symbiotic trauma – case studies Vasile D.L............................................................................................................................................................ 1061 Session XXI. Assessment of Resilience
Resilience in university students: Multisite study in France, Quebec, Romania, Algeria and Rwanda Ionescu S., Jourdan-Ionescu C., Bouteyre E., Muntean A., Nini M.-N., Rutembesa E., Aguerre C........ 1065
Construction and validation of the resilience assessment scale for infertile couples (rasic) Dumitru R., Turliuc M.N. ................................................................................................................................... 1069
Resilience and psychosocial adaptation scale for persons with moderate and severe traumatic brain injury Hamelin A., Jourdan-Ionescu C., Boudreault P............................................................................................. 1075
The assessment of the resilience of people with cognitive impairments or intellectual disabilities Julien-Gauthier F., Jourdan-Ionescu C., Martin-Roy S., Ruel J., Legendre M.-P. .................................... 1079
Resilience and metacognitions as predictors of outcome in a randomized controlled treatment trial of generalized anxiety disorder Hjemdal O., Hagen R., Ottesen Kennair Leif E., Solem S., Wells A., Nordahl H. ...................................... 1083
Projective assessment of resilience Jourdan-Ionescu C............................................................................................................................................ 1087 Session XXII. Emotional Regulation, Positive Psychology and Resilience
Humor and mental health in the elderly Antonovici L., Soponaru C., Dîrţu M.-C. ......................................................................................................... 1091
The role of motivational persistence and emotional dynamics in changes of well-being Bostan C.M., Constantin T., Aiftincăi Andreea M.......................................................................................... 1097
Secondary traumatic stress, dysfunctional beliefs and the moderator effect of compassion satisfaction Crumpei I............................................................................................................................................................. 1103
Facilitating factors and consequences of experiencing self-detachment in groups: A thematic analysis Gherghel C., Nastas D....................................................................................................................................... 1107
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Predictors of emotion regulation during the transition from adolescence to young adulthood Turliuc M.N., Bujor L. ........................................................................................................................................ 1111 Session XXIII. Assisted Resilience and Promoting of Resilience
Towards a somatic resilience? Bernoussi A., Masson J.................................................................................................................................... 1117
History of life analysis: Assisted resilience perspective Bucur E., Bucur Venera M. ............................................................................................................................... 1123
The function of art therapy in self-knowledge, self esteem and interpersonal relationships in children with emotional disorders Campean V.F., Drăgan-Chirilă D., Chirilă E., Câmpean D.L......................................................................... 1129
Resilience between constitutive structure and behavioral response: A psychoanalytic approach Ciomos V. ........................................................................................................................................................... 1135
Self-care and resilience in the context of chronic disease. A qualitative study Cojocaru D.......................................................................................................................................................... 1141
Proximal effects of an intervention for children bereaved by the suicide of a parent: Will they be more resilient? Daigle Marc S., Labelle J. Réal......................................................................................................................... 1145
Presentation of the «Theater of resilience» device Fauche-Mondin C. ............................................................................................................................................. 1149
Migrant families and disabled child: Promoting resilience through life story Pierart G.............................................................................................................................................................. 1155
Enhancing the resilience of students with intellectual disabilities in the transition from school to working life Martin-Roy S., Julien-Gauthier F., Jourdan-Ionescu C. ............................................................................... 1161
Shamanic practices and assisted resilience Masson J., Bernoussi A.................................................................................................................................... 1165
Reflections on the relationship between psihotrauma (PT) and assisted resilience Milea S................................................................................................................................................................. 1171
Artistic languages as an educative tool to promote resilience Mundet A., Fuentes-Peláez N., Pastor C......................................................................................................... 1175
A process – systemic oriented working model in trauma psychotherapy Nedelcea C., Ciorbea Iulia D............................................................................................................................. 1181
The promotion of resiliency by counseling Oancea C., Budisteanu B. ................................................................................................................................ 1187
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Measures for assisted resilience for a group of institutionalized teenagers from Romania Raducanu Ioana A., Rășcanu R....................................................................................................................... 1191
Side by side Ragea C............................................................................................................................................................... 1195
Tutors of resilience: Importance for incest victims Romano H., De Moura S., Scelles R................................................................................................................ 1199
Art therapy an effective means in the psychological resilience Rusu M. ............................................................................................................................................................... 1205
Sports as a protective factor in adaptation to disability Sikorska I. ........................................................................................................................................................... 1209
“Treasures of the winning couple” program for young children in Israel: Bodymind coping skills for stress reduction and enhancing resilience Tal-Margalit M., Spanglet J............................................................................................................................... 1213
Resilience indicators in psychotherapy Vîşcu L.-I. ............................................................................................................................................................ 1217
Using the „six part story-making” model to increase resilience in children from divorced families Vladislav Elena O., Marc G............................................................................................................................... 1221
Integrative treatment of depression and its impact on quality of life and resilience in cancer patients Zarie G................................................................................................................................................................. 1225 Session XXIV. Clinical Approaches of Resilience in Crisis Context
Ecosystemic assisted resilience intervention Jourdan-Ionescu C............................................................................................................................................ 1231
Dialectical behavior therapy and resilience in suicidal adolescent: The Quebec experience in psychiatry Labelle Réal J., Janelle A., Mbekou V., Renaud J. ........................................................................................ 1237
Building resilience in crisis situations: The Lebanese experience of the Center for the war child and family Gannagé M.......................................................................................................................................................... 1241 Session XXV. Meaningful Programs that can Enhance Change: Lessons Learned by “Community Foundation” – MOL Romania
Assisted resilience in emotional therapy and art therapy András I., Török Melinda M., Pap Zsuzsa I., Ilyés I........................................................................................ 1245
Promoting the resilient process for deaf children by play and drama therapy Cernea M., Neagu A., Georgescu M., Modan A., Zaulet D., Hirit Alina C., Ninu A., Filip C., Stan V. ...... 1251
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Group resilience, community support and associative behavior – lessons learned from a grant scheme program Ciumăgeanu M., Predescu S., Tar G., Stan V. ............................................................................................... 1255
Adventure and art therapy programmes for chronically ill children. The MOL child healing programme Török S................................................................................................................................................................ 1259 Session XXVI. Bricollage, Resilience and Change: Gypsy, Traveller and Roma Strategies of Survival and Adaptation in the Trans-National Context
Romani mobilities as resilience strategies: Trans-atlantic expectations, lives and journeys Acuña Cabanzo E. ............................................................................................................................................. 1263
A gypsy and traveller journey through foster care: Emotional resilience versus the experience of being shamed Allen D................................................................................................................................................................. 1269
Why Roma migrants leave or remain settlements? Different strategies of survival and adaptation among Roma in northern Italy Manzoni C. .......................................................................................................................................................... 1273
A few steps away: Two schools, two different worlds. The capacity of resilience in the Calòn identity building Persico G. ........................................................................................................................................................... 1277
Beyond bereavement: Exploring resilience in gypsy and traveller families following bereavement Rogers C. ............................................................................................................................................................ 1281
‘Putting the last first’ - how participatory action research can turn things around for Roma communities Vajda V. ............................................................................................................................................................... 1287 Session XXVII. Papers presented on the Poster Session
Assessing adolescent resilience Bekaert J............................................................................................................................................................. 1293
The management of resilience in organisations Brate Adrian T. ................................................................................................................................................... 1301
The perception of resilience and indicators of occupational stress Brate Adrian T. ................................................................................................................................................... 1305
Family functioning – resilience factor for children and adolescents with psychopathological disorders Gheorghe Ramona O., Bancuta N., Tudorache E., Oros Anca D., Ipate L., Isac Eduard V., Manasi V.. 1311
Having a parent with a psychiatric disorder: The development of resilience Hurmuz M., Lazarescu M., Stan V., Ienciu M., Popescu A., Bredicean C., Stroescu R., Papava I.......... 1321
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Psycho-social cognition of elders’ quality of life and assisted resilience measures Rascanu R., Rugescu Ana-Maria M., Macovei Melania M............................................................................ 1327
Resilience through the Christian Religion inside the communist prisons in Romania Rusu G., Popescu I............................................................................................................................................ 1331
Researching resilience: The need for networked methods Sánchez Martí A., Vázquez Álvarez N., Velasco Martínez A., Soria Ortega V. .......................................... 1335
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The Mourning and Resilience of People who have Suffered Significant Losses Costin A. Aurel Vlaicu University of Arad (ROMANIA)
[email protected]
Abstract This paper makes an analysis of the mourning facilitated by a study that is in progress on the identification of differences in the resilience in people (Christians versus atheists) who have suffered significant losses. We have presented some impressions about how believers respond/ react to death. We found that exceeding the critical period is conditioned for Christians by their resilience which is based also on their beliefs regarding death. Keywords: mourning, resilience, support forms
Introduction Death is the most disconcerting, incomprehensible and in even in some way fascinating event, that a human being can live throughout his life. Anthropologists, philosophers, theologians and psychologists have approached death from different perspectives. The main crossing will remain an ongoing concern for people. Why? Because in one way or another we all face our own death. And this is not the most "feared" experience; to remain alive after the death of a loved one, this is truly a trauma or, even more than, it is the beginning of a new life, "I did not believe I would ever learn to die," said Eminescu. But this is exactly what we should do when we lose a loved one: learn to accept and above all to understand and to live without the person who has disappeared. We approached this issue to highlight the need to understand death as a stage or a step in the process of adapting to a life without the person who died. Death itself is disturbing even for a person who assists from the outside and who is not emotionally involved. The event bears significant experiences, it raises questions, it calls for meditation and reflection, but the tumult of life or even the defence systems lay a blanket of forgetfulness after some time. It is not the same case for the person who has suffered the loss directly: one’s spouse, one’s parent, one’s child, one’s brother etc. And yet life continues, the person is forced to go on. Sometimes one cannot even conceive life after one’s loss, yet we have witnessed the incredible recoveries of people who have experienced total collapse.
Aspects concerning resilience "Resilience can be defined as one’s capacity to cope with adversity and continue one’s personal development" (Tomita, 2009). Resilience is a term used in psychology that characterizes the person who has the skills to effectively and relatively recover from failures or losses in a short period of time. Being resilient is a very valuable skill in our days, when the pressure we are exposed to, the speed with which we move, the uncertainty that we feel in all areas of life can lead to critical situations. There is no need to refer to an important loss (the death of someone close) to talk about resilience; the loss of one’s home, one’s job or simply to cope with life as it is right now, involves a process of resilience. In popular language it is said that "what does not kill you makes you stronger"; this is exactly what Taylor [2] says, namely the fact that traumatic experiences can have a positive impact on the development of a person, and Tedeschi and Calhoun [3] detail the benefits of such experiences: to appreciate life more, to have closer relationships with others, spiritual flourishing, changing priorities and especially an increased personal power.
Methodology This paper presents the partial results of a study which is ongoing and which aims to identify differences in people’s resilience (Christians versus atheists) who have suffered significant losses. So far we
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have conducted 50 interviews with people who have suffered significant losses; 12 of them have lost their children (four as a consequence of accidents). The study shows that each of the respondents feel a pressing need to understand "why" everything happened, especially in the case of accidents, where death was sudden and the event was of course unanticipated. In the first phase of our endeavour, the interviews were applied to individuals who attend Orthodox churches in Arad, followed by questioning other 50 people who consider themselves atheists. Both categories of respondents fall into different levels of education, age, residence. The variables which differentiate the reactions and manifestations of the respondents are: age, sex, time elapsed since death, their perception of death, the quality of the relationship with the deceased, the family of origin. Practically, this study aims to make a rapid radiography of the mechanisms by which faithful believer versus atheist people succeed in rehabilitating themselves emotionally after a loss. I will hereby present an issue which distinguished itself in all the interviews, namely the respondents’ urgent need to understand death itself, the significance and the meaning of the loss they have endured.
Which are the stages and mechanisms typical to the process of resilience in this case? Losing an important person causes severe emotional distress accompanied by a tumult of feelings: the person agonizes, he/she becomes anxious, overwhelmed by feelings of loneliness and longing, abandonment and guilt. This pain affects the self-image of the person in question, who is lost in dreams and experiences suicidal thoughts. The whole being of the person who suffers the loss collapses; the universe that he/she had perceive in a particular way is reconfigured as frightening, while the prospect of life without the lost person is inexistent. But these are just some of the types of pain: stillness, storms of movements, illogical movements or dissociative experiences complete the picture of its manifestations [1]. What follows is the logical and natural manifestation of certain techniques of emotional adjustment and adaptation to the new situation. I have studied the phase we experience when we undergo a trauma; if the traumatic event does not permit an adjustment, then we have to go through the following stages:
The shock phase : it is the first phase, when we refuse to accept reality and all its related emotions: insensitivity, denial and depersonalization, selective forgetfulness; The action phase, or the awareness of the loss associated with states of anger, depression, guilt; Experiencing the loss/ mourning; Acceptance of the loss; The discharge phase: This necessarily involves the discussion of experienced events, the need for social and specialized support. This is the moment when the person actually returns to his/her life.
In an interview with Vasile Diana, a specialist is psycho-traumatology she said that "psychological injuries are part of our human nature, they are necessary to form our uniqueness and to enable us to evolve." The same author emphasizes the importance of The National Congress of Psycho-traumatology held last year, which aimed at stimulating precisely those areas that can improve psychological disruptive effects of trauma and which can lead to the healing of the human being. The congress slogan was: “Beyond Trauma: resources and opportunities”.
Understanding death as a stage in the recovery of the person who suffered a significant loss The recovery or mourning process itself usually takes, according to experts, one year or two, during which the person left behind tries to give new meanings to death. One needs to understand where his/her loved one went, why, how the split will be like, how long etc. Therefore, understanding death, respectively granting new meanings to the separation that can allow him/her to go on, is a highly important step in the recovery process. The belief that the suffering we are experiencing has meaning and that life itself, as well as death, have their meaning in God, offer a new perspective on life. It's amazing how people manage to rebuild their lives giving explanations and justifications of the tragic events of their lives: some turn to superstition, others abandon God, others take it as it is. It seems that most people embrace the religious dimension by giving biblical explanations to death. Meeting again “sometime” with the lost person appears to be the only hope left for the survivor. As life seems pointless immediately after a loss, a feeling that continues for a year or two, the person needs to grant meanings to the event, trying to give a justification of death. An old curiosity I had about this topic was: how do people overcome moments of anguish after the death of someone who was very close (especially children, parents or siblings).
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Some of the findings that have guided the people surveyed in accepting the deaths of his/her offspring or life partner were: "he/she had a great soul...God wanted him/her beside him", "Both children died...now they are together in heaven", "I cannot breathe because of the pain...the only thing that helps is knowing that God took him". It seems that the prospect of a meaningless death is hard to accept. Some people turn to God, while others tackle death objectively: "he didn’t die because God wanted it...he died because he was very sick." The emotional support that those interviewed received was mainly provided by: a confessor, a psychologist and the family. There are slight differences between the number of people who sought the help of a priest (28), as opposed to the number of those who attended psychotherapy sessions according to their level of education (25). 14 people received both versions of support. The search for connections between the traumatic event and family history is apparently an important dimension in the process of resilience:
that the child's death had occurred due to a sin or a curse cast on the family a long time before; the spouse died because it is a third-generation family in which the young woman becomes a widow; the child's death is a punishment for the mother who had intervened in her present husband’s marriage, determining his separation from his first wife and their child, whom she forbade him from meeting; God punished them by "taking" their child because the whole family (both parents, grandparents and relatives) were people "without God."
By recognizing the absolute power of God who made justice, even in this painful way, people seem to accept His decision by resigning gradually. Others think that the baby would not have deserved such a fate, as they all thoroughly respected all moral norms, but they accept that God's actions have meanings which cannot be understood by people. An interesting aspect noted by several people interviewed was the importance of the requiem in the process of parting from the deceased. Commemorations are important forms of support for the survivors: they are occasions where they "can still do something" for the lost person; by carefully studying their perception of these commemorations we could see that they empower the survivors through they bare. In the Orthodox rite, nine days after death the soul of the deceased needs prayer and help from the living to continue its journey, prayer and almsgiving, which are realized in the service of the Divine Liturgy. This moment also has a psychological significance: by taking place very soon after the death, when the survivor still processes the experience of a close one’s death, it is a new step in the awareness of the events that took place. Thus, the prayer is an instrument through which the man-God and the deceased are united. Prayer therefore becomes a task to the parent who has lost one’s parental roles following the child's death; "he can still help the child, he can still provide the child with peace wherever he may be." On the same level we can also find the benefits/ handouts to the poor, which are designed to facilitate the journey of the deceased. Psychologists use numerous methods to overcome grief, including:
The evocation of pleasant events/ moments with the deceased through the use of symbols such as photographs, letters etc.; The termination of the relationship with the deceased by writing a letter which expresses all of one’s emotions; Expressing feelings through drawing.
Only 14 of the respondents requested mourning therapy which they consider highly beneficial, stating that "I do not think I would have borne it without the support of a psychologist." Thus, the Christian perspective on death is the most "required" by the suffering person who remains after one has died. It is a typically human attitude, that of needing to be abandoned, to believe that someone powerful controls everything, who leaves nothing to chance and who has a plan for everyone. The fact that death is not a final separation but only a temporary separation seems to be the most effective theory for the Christian who has suffered a loss. If we made a summary of the resilience of people who have lost someone close, we could point out the following attitudes/ beliefs that constitute forms of support to go on in life:
Trust in God's will (death happened as a result of God's plan); Trust that the deceased is in a better place, that he/she is well, wherever he is; Trust in the fact that the prayers of the living help them; Hope that they will meet once again; The support of others; Responsibilities to other family members; Continuing life as a duty to God.
It should be noted that there are behaviours that indicate non-acceptance of death (more than 3 years after death) but which represent a way to continue the relationship with the deceased. Women become rather
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depressed in these situations while men sink into labour until exhaustion or prefer oblivion by consuming alcohol.
Conclusions The period of mourning is considered a major depressive episode in our lives. Depending on certain factors, mourning lasts from one year to three years according to specialists but loss impressions for life in some cases. The family support or even specialized support (psychological or religious) is very valuable to the person, giving desire and motivation to continue life after the loss of the loved ones. Understanding the meaning of death, the reasons the tragedy happened (such as the death of a child) are important moments in mourning. The need of those interviewed ( to believe that separation is not final , that God had a specific plan and that He controls everything, etc ) are Christian beliefs which works as a defense mechanism in situations that severely jeopardize the emotional balance. Overcoming this period of mourning varies from one person to another depending on its resiliency, on the context in which the event occurs, the quality of the relationship with the person who died, etc. At the same time, this experience gives the person the skills and abilities to adjust to critical situations and to overcome traumatic events.
References [1] [2] [3] [4]
Constantin, A.M., (2003), Terapia de doliu sau confruntarea cu moartea, în: Mitrofan, I., Cursa cu obstacole a dezvoltării umane, Editura Polirom, Iaşi, p.350 Taylor, S.E. Adjustment to threatening events: A theory of cognitive adaptation (1983), apud. Ionescu, Ş., Tratat de rezilienţă asistată, Editura Trei, Bucureşti, (2013), p.30 Tedeschi, R., & Calhoun, L., Trauma and transformation Growing in the aftermath of suffering Rhousands Oaks,CA:Sage, (1995-1996) apud. Ionescu, Ş.,, Tratat de rezilienţă asistată, Editura Trei,Bucureşti, (2013), p.30 Tomiţă, M., Factori de rezilienţă la adolescenţii adoptaţi la vârstă mică, în Revista „Copiii de azi sunt părinţii de mâine”, (2009), nr 25, p 14.
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The Experience of Resilience in People Recovered from Bipolar Disorder Echezarraga A.1, Las Hayas C.2, González-Pinto A.M.2 & 3, López M.P.2, Luis P.4, Echeveste M.5 1
Faculty of Psychology and Education. University of Deusto (Biscay. SPAIN) Santiago Apóstol Hospital, Psychiatry Service (Álava. SPAIN) 3 CIBERSAM: Grupo González-Pinto Arrillaga (SPAIN) 4 Mental Health Center of Bombero Echaniz (Biscay. SPAIN) 5 Mental Health Center of Adults of Uribe-Kosta (Biscay. SPAIN)
[email protected] 2
Abstract Resilience is a dynamic process that aims to overcome adversity through the development of positive qualities. Bipolar Disorder (BD) is an adverse experience, considered a serious mental illness (SMI) and characterized by cyclical and extreme moods fluctuations between mania/hypomania and depression. The objective of this study is to explore the phenomenon of resilience, its process and factors involved in adults recovered from BD. This is a qualitative study using semi-structured interviews and focus groups with people recovered from BD belonging to the mental health network from the Basque Country (Spain), and clinical experts in the treatment of BD. All the content from the focus groups and interviews was transcribed and analyzed according to the conventional content analysis. People recovered from BD affirmed having experienced a resilient process. It was described as progressive, dynamic and non-linear experience. During the resilient experience inner strength emerged, providing hope and confidence in getting better and displaying and developing interrelated internal and external qualities in order to overcome the BD. Some of the resilient qualities developed involved a self-analysis, being responsible for own mental health, searching for emotional, physical and social balance and wellness, selfreinvention or reorienting a personal life project, activating some positive personality characteristics (traits), employing conflict resolution ability, and finding external (formal and informal) support. Resilience arose after experiencing a life crisis (i.e. turning point) and the person was determined to overcome it. People recovered from BD reported having experienced resilience. The resilient qualities found coincide with the traditional qualities of resilience, while others are specific to BD. It is recommended to continue the study of resilience in longitudinal studies to analyze whether resilience predicts recovery. Keywords: Resilience process, Resilience factors, Mental Disorder, Bipolar Disorder, Qualitative study.
Introduction The study of health is showing a shift from an epidemiological to a salutogenic approach, which aims to study phenomena that enable a satisfying and healthy life despite adverse life circumstances. Positive psychology asserts that the study of positive human traits enables understanding how to build qualities that not only help to resist and survive, but also to grow or thrive, to reduce, regulate and prevent mental illness as a side effect [1]. Some autobiographical reports show that although bipolar episodes are traumatic and disruptive, there is a possibility that people with Bipolar Disorder (BD) can experience wellness and manage their disease and live a fulfilling life, describing a variety of strategies to achieve it [2]. Nevertheless, the positive reports of living with BD remain largely absent in the current research literature, studying instead the high rates of suicide, substance abuse, criminal behavior and divorce. BD is a mood disorder characterized by recurrent and cyclical periods of extreme moods, including depression –during which sadness, inhibition and ideas of death prevail- and mania –which is a phase of exaltation, euphoria and grandiosity- or hypomania [3]. BD is a chronic disease with periods of remission and relapse. Along the course of the disease, the patient may develop psychotic symptoms, rapid cycling, psychiatric and medical comorbidity, and cognitive and psychosocial impairment. Patients have a high risk of committing suicide.
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This illness remains in the top ten causes of Years Lived with Disability (YLD) at global level, accounting for 2.5% of total global YLDs [4]. It is incorporated by the World Health Organization (WHO) as one of the six most debilitating conditions [5] and also classified among the Serious Mental Illness (SMI) [6]. According to the WHO World Mental Health Survey Initiative [7], the aggregate lifetime prevalences were 0.6% for bipolar type I disorder (BP-I), 0.4% for BP-II, 1.4% for subthreshold BP, and 2.4% for Bipolar Spectrum Disorder (BPS). To be in line with the focus of current salutogenic approach and cover the lack of knowledge of positive qualities that contribute to recovery in this high health burden disease, the present study aims to study psychological resilience in BD. According to several authors such as Grotberg [8] and Luthar, Cicchetti, & Becker [9], the resilient term must be understood as a universal and dynamic process in which both personal and interpersonal skills, as well as internal forces interact to allow positive adaptation despite adversity. Other authors argued that individual psychological variables are an essential part of resilience in terms of adverse circumstances [10]. Moreover, Richardson [11] and Grotberg [12], not only describe resilience as a disruptive and reintegrative process for accessing resilient qualities towards overcoming adversities, but also as a phenomenon that strengthens protective factors and drives to personal growth through adversity and disruptions. There is evidence of the importance of resilience to overcome adverse events on somatic health and physical problems [13] as well as on mental ones [14]. Grotberg maintains that resilience is recognized as a contribution to the promotion and maintenance of mental health and quality of life [12]. For instance, a study found the presence of resilient qualities in a sample of eight participants in remission of various mental disorders, including BD [15]. Meanwhile, it has been shown that resilience could play an essential role in personal recovery and in improving psychosocial functioning and quality of life as well as in reducing symptoms in people with schizophrenia [16]. However, the review of the scientific literature by the major search engines (Web of knowledge, Ebscohost, Pubmed and Google Scholar), and the combination of keywords, "resilience" or "resilient "and "bipolar disorder" did not produce any results in reference to psychological resilience. Therefore, the primary aim of the study was to explore from a qualitative perspective the resilience process phenomenon and the positive qualities or factors involved in it within a clinical adult sample of people recovered or functionally improved from BD. It is hypothesized that resilience is experienced by these individuals and it will be described as a multidimensional process. Also it is expected to find a number of resilient components similar to those studied in other diseases and adversities, and a few BD specific resilient components. Moreover, it is hypothesized that people affirmed having experienced a resilient process would also display high rates of posttraumatic growth and quality of life.
Methods 1.1
Design
This is a phenomenological qualitative study. Multiple triangulation technique was used: a) Methodological triangulation (semi-structured individual interviews and focus groups), b) Data triangulation (focus groups composed of both people recovered or functionally improved, as experts in the area), c) participants with BD also completed a battery of tests.
1.2
Participants
Participants came from various psychiatric services and Mental Health Centers of Basque Country (Spain): Mental Health Center Bombero Echaniz and Uribe-Kosta from Biscay, and Santiago Apostol Hospital from Álava. The inclusion criteria for the individual interview and focus group patients were: (1) be functionally recovered or significantly improved from their BD diagnosis (BD type I, type II, and not Specified diagnosis were accepted). Additionally, a psychiatrist of each BD participant had completed the “Clinical Global Impression Scale for Bipolar Disorder Modified (CGI-BP-M)” [17]. To be eligible to participate, participants symptoms had to had been rated as "normal" and "mild" in severity. (2) Be between 18 and 65 years old. (3) Have appropriate levels of expression, understanding and insight to carry out the study. (4) Participate based on informed and voluntary consent. Patients who (1) did not meet the above criteria and (2) that also had other psychological, biological or physical conditions that would impede participation in the study were excluded. The inclusion criteria for participating experts in the focus group were: (1) Possess more than two years of experience in treating patients with BD, and (2) agree to participate in an informed and voluntary way.
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1.3
Procedure
The study satisfies ethical aspects of informed consent, voluntary participation, and confidentiality. Participants gave the informed consent to participate and they also allowed the interview to be taped in audio. Therefore, each interview and focus group was fully transcribed on paper. Conventional content analysis [18] of each individualized interview and focus group was performed following steps proposed by Morse & Field [19] in order to identify most relevant topics, leading to the creation of a final model of resilience in BD. The first draft model of resilience was obtained from the individualized interviews in which patients were asked about their resilient experience, and about qualities used during this process. Later, a patient focus group was carried out in order to discuss their resilient experience and validate the created first resilient model. This led to the creation of a second draft model of resilience, which was presented to six mental health professionals that participated in the expert focus group. They discussed and validated the second draft model of resilience from their objective view of the topic. Last, a final model of resilience in BD based both on users and on professionals views was created.
1.4
Instruments
Patients had to complete standardized questionnaires about their symptoms of BD “Bipolar Spectrum Diagnostic Scale (BSDS) Spanish Version” [20], general resilient level “Spanish Version of the Resilience Scale 25 (RS-25)” [21], posttraumatic growth “Short Form of the Posttraumatic Growth Inventory (PTGI-SF) Spanish version” [22], quality of life “Brief Quality of Life in Bipolar Disorder (Brief QoL.BD) Spanish Version” [23], and socio-demographical and clinical data. Additionally, an analogical visual scale (AVS) for recovery ranging from 0 "I have not experienced any recovery" to 100 "I am completely recovered" was administered. Experts completed the “CGI-BP-M” [17] of their patients to report the severity of symptoms at present.
1.5
Statistical Analyses
Descriptive statistics and frequencies were performed, using the statistical package SPSS for Windows version 20.
Results 1.1
Quantitative Data
According to CGI-PB-M (Overall) and BSDS mean scores, participants showed no significant active BD symptoms (M = 1.60, SD = 0.83, within the range “Normal (1.00)” and “Minimal (2.00)”; M = 2.73, SD = 2.40, mean score was below the cut off value of 13 points necessary for screening BD). Furthermore, patients indicated to be highly recovered in the AVS for recovery (85.00, SD = 11.01). Of the 15 patients enrolled (11 women , 4 men), nine of them from Santiago Apóstol Hospital, and six from Mental Health Center Bombero Echaniz and Uribe–Kosta, with a mean age of 42.87 years old (SD = 11.99), 7/15 were married, while most of the others were single (6/15) at the time of the interview or focus group. Although 8/15 patients had university degrees, and 4/15 worked in a job related to their university degrees, the majority of patients (11/15) were occupationally inactive at the time of the interviews were taped (mainly by occupational disabilities resulting from the BD). BD came out in early adulthood (M = 25.00 years old, SD = 9.71). All were receiving prescribed drug therapy (predominantly antipsychotics, mood stabilizers and anticonvulsants) and most had also received individual and/or group psychological therapy. Some participants indicated the presence of thyroid-related diseases as a side effect of the lithium carbonate. Participants show medium-high levels of intrinsic factors in resilience, posttraumatic growth, and quality of life indicated by the mean scores of RS-25, PTGI–SF, and Brief QoL.BD (M = 137.80, SD = 16.97, range 25-175; M = 32.87, SD = 7.23, range: 0-50; M = 48.80, SD = 6.89, range: 12-60, correspondingly).
1.2
Qualitative Data
All patients affirmed having experienced a resilient process, which was described as a progressive, dynamic and non-linear process. The qualities or factors that contributed to the origin and function of resilience in BD are described in the diagram presented in Fig.1.
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Fig. 1 Factors that contribute to the origin and functioning of Resilience in Bipolar Disorder Process
Participants agreed that resilience was originated within the context of having a minimal mental health condition. Being there they went through a bipolar crisis, and experienced positive flashbacks that made them feeling well. This situation worked as a revealing experience, which led them to a turning point. In this context, they referred feeling an enhanced commitment to change one’s beliefs and attitudes and being determined to face the crisis. This generated an inner strength or motivation and increased hope and confidence in order to get over the adversity. In this context, participants narrated the development and activation of various interrelated positive qualities which enabled them to overcome the BD: 1) Self-analysis: They agreed that self-knowledge about personal strengths, weaknesses, goals, values, and hobbies allowed them to redefine their identity and to differentiate themselves from the illness. 2) Being responsible for own mental health: They stressed the importance of knowing about the clinical features of BD, and trying to regulate it through the management of early warning signals and the adherence to psychopharmacological treatment. That gave them sense of empowerment above their lives. They also narrated the importance of dealing and re-establishing personal limits. 3) Searching for emotional, physical and social balance and wellness: Having a discipline and a healthy lifestyle, as well as having or searching for an interpersonal and occupational network in order to perceive emotional support. Participants agreed that enjoying relaxing and distracting activities were also necessary so that they could set aside their suffering. 4) Self-reinvention or reorienting a personal life project: These factors implied to undertake personalized goals that nurture one´s inner life. They also narrated the need for self-realization and personal growth, which it was also strengthened as a result of resilient process. 5) Activating some positive personality characteristics (traits) such a self-worth, courage, perseverance, humility, extroversion, optimism and sense of humor. 6) Employing present focused conflict resolution ability or being able to do an objective analysis of the problem and available resources. This allowed them to adapt their goals and to find out and get needed support to solve their problems. Creativity, assertiveness and social skills were also emphasized. 7) Finding external support both formal (psychopharmacological therapy) and informal (family, friends and colleagues).
Conclusions The study provides evidence that resilient process is an experience in people recovered from BD. The resilient qualities found coincide with the traditional qualities of resilience [8, 9, 10] such as hope, optimism, creativity, dreams, self-control, and subjective wellness, while others are specific to BD, such as BD knowledge, redefinition of identity, and adherence to treatment. On the other hand, a few studies have explained a number of factors related to recovery from BD such as identity development, self-management, and development of social roles [2], when actually, they are resilient factors that lead to recovery. In addition, this study provides evidence that people recovered from BD and have gone across a resilience process, also show medium levels of quality of life and posttraumatic growth. This study involved a small number of people. However, data saturation was obtained in individualized interviews and multiple triangulation was carried out, thus giving more validity to the results. An added limitation was that all patients with BD were recovered, so precautions should be taken when generalizing the results to people with active BD. However, as it is the first study in the area, people who more likely had
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experienced resilience (ergo the recovered ones) had to be included in the study in order to ensure the exploration of the resilient phenomenon. It is recommended to continue the study of resilience in longitudinal studies to analyze whether resilience predicts recovery. The severity of BD and the resulting socioeconomic and health burden [24] could be reduced through the development of specific resilience programs for people with BD that promote recovery.
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20]
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Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology: an introduction. American psychologist, 55(1), 5. doi: 10.1037/0003-066X.55.1.5 Mansell, W., Powell, S., Pedley, R., Thomas, N., & Jones, S. A. (2010). The process of recovery from bipolar I disorder: A qualitative analysis of personal accounts in relation to an integrative cognitive model. British Journal of Clinical Psychology, 49(2), 193-215. doi: 10.1348/014466509X451447 American Psychiatric Association (Ed.). (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR®. Washington, DC: Author, 2000 (Trad. Castellano, Barcelona: Masson, 2002). World Health Organization. (2001). The World Health Report2001 – mentalhealth: new understanding: in World Health Organization (ed): New Understanding, New Hope, Geneva: WHO. Murray, C. J., & Lopez, A. D. (1997). Mortality by cause for eight regions of the world: Global Burden of Disease Study. The Lancet, 349(9061), 1269-1276. http://dx.doi.org/10.1016/S0140-6736(96)07493-4 Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593. doi:10.1001/archpsyc.62.6.593 Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A., ... & Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of general psychiatry, 68(3), 241. doi:10.1001/archgenpsychiatry.2011.12. Grotberg, E. H. (1995). A guide to promoting resilience in children: strengthening the human spirit. La Haya: Bernard van Leer Foundation. Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child development, 71(3), 543-562. doi: 10.1111/1467-8624.00164 de Terte, I., Becker, J., & Stephens, C. (2009). An integrated model for understanding and developing resilience in the face of adverse events. Journal of Pacific Rim Psychology, 3(01), 20-26. doi: http://dx.doi.org/10.1375/prp.3.1.20 Richardson, G. (2002). The metatheory of resilience and resiliency. Journal of Clinical Psychology, 58(3), 307–321. Doi: 10.1002/jclp.10020 Grotberg, E. (2003). Nuevas tendencias en resiliencia. Resiliencia, descubriendo las propias fortalezas, 27-29. Emlet, C. A., Tozay, S., & Raveis, V. H. (2011). “I’m Not Going to Die from the AIDS”: Resilience in Aging with HIV Disease. The Gerontologist, 51(1), 101-111. doi: 10.1093/geront/gnq060 Dowrick, C., Kokanovic, R., Hegarty, K., Griffiths, F., & Gunn, J. (2008). Resilience and depression: perspectives from primary care. Health: An Interdisciplinary Journal For The Social Study Of Health, Illness & Medicine, 12(4), 439-452. doi:10.1177/1363459308094419 Edward, K., Welch, A., y Chater, K. (2009). The phenomenon of resilience as described by adults who have experienced mental illness. Journal ofAdvanced Nursing, 65(3), 587-595. Torgalsbøen, A. K. (2012). Sustaining Full Recovery in Schizophrenia after 15 Years: Does Resilience Matter? Clinical Schizophrenia & Related Psychoses, 5(4), 193-200. doi: 10.3371/CSRP.5.4.3 Vieta, E., Torrent, C., Martínez-Arán, A., Colom, F., Reinares, M., Benabarre, A., . . . Goikolea, J. M. (2002). Una escala sencilla de evaluación del curso del trastorno bipolar: la CGI-BP-M. Actas Españolas de Psiquiatría, 30(5), 301-304. Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative health research, 15(9), 1277-1288. doi: 10.1177/1049732305276687 Morse, J. M., & Field, P. A. (1995). Qualitative research methods for health professionals (2nd ed.). Thousand Oaks, CA: Sage. Vázquez, G. H., Romero, E., Fabregues, F., Pies, R., Ghaemi, N., & Mota-Castillo, M. (2010). Screening for bipolar disorders in Spanish-speaking populations: sensitivity and specificity of the Bipolar Spectrum Diagnostic Scale-Spanish Version. Comprehensive Psychiatry, 51(5), 552-556. doi: 10.1016/j.comppsych.2010.02.007 Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the Resilience Scale. Journal of Nursing Measurement, 1(2), 165-178.
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[22]
Cann, A., Calhoun, L. G., Tedeschi, R. G., Taku, K., Vishnevsky, T., Triplett, K. N., & Danhauer, S. C. (2010). A short form of the Posttraumatic Growth Inventory. Anxiety Stress Coping, 23(2), 127-37. doi: 10.1080/10615800903094273 [23] Michalak, E.E., Murray, G., & CREST.BD. (2010). Development of the QoL.BD: a disorder specific scale to assess quality of life in bipolar disorder. Bipolar Disorders, 12, 727–740. [24] Woods SW. (2000). The economic burden of bipolar disease. J Clin Psychiatry, 61 Supp 13, 38-41.
Acknowledgments This research was supported by the predoctoral grant “Research Training Grant Programme” from the University of Deusto (Bilbao, SPAIN) to the first author (Echezarraga Porto, Ainara). This study would not have been possible without the help of the following psychiatrist: Enrique Aragüés, Begoña Mendibil, Ángel Segura, and Pablo Malo.
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Identifying Protective Factors in adults – a systematic review to inform Resilience-Building Programs Höfler M. Friedrich Schiller University Jena (Germany) Institute of Education and Culture/ Chair of Adult Education
[email protected]
Abstract Objective: This study aims to identify validated psychological protective factors that promote healthy mental development in adults confronted with life-risks. Background: Adult education aims to identify protective factors that build resilience with the goal of creating the foundation for resilience-building interventions. However, the expansion of empirical research on adult resilience has brought problems in terms of systematically comparing and combing heterogeneous studies. Factors that should be integrated into resiliencebuilding measures must be validated by research which defines specific protective effects with regard to specific groups. Methodology: A systematic review on empirical studies was conducted across six databases. Inclusion criteria were relational resilience concept, stress-inducing risks, population aged 18 and older, psychological factor type, interactive protective effect, mental-health-related outcome, and, to make a qualitative pre-selection, a minimum two-fold confirmation of protective effects throughout longitudinal studies with no conflicting results. Results: The database search resulted in 664 studies; six studies matched all inclusion criteria. Validated factors were perception of personal control, responsibility, and socialization. Conclusion: The validated protective factors should be discussed in the context of mental-health-prevention programs targeting adults. Keywords: resilience, adults, systematic review, protective factor, mental health, adult education.
Introduction Resilience researchers suggest that future studies which aim to identify protective factors that are consistently associated with resilience are necessary for intervention research [1]. Adult education aims to identify factors that promote resilience, with the goal of developing resilience-promoting programs. However, the expansion of empirical research on adult resilience has brought problems of comparability between heterogeneous studies due to the lack of a consistent theoretical base which has made it difficult to combine results systematically. When a protective effect of a factor is validated in a specific study population, this does not mean that this factor is protective in another population and in the same way. Resilience research shows the interdependence between protective effects in terms of population characteristics, for example risk-type [2], risklevel [3], gender [4] and age [5], as well as in terms of the focused outcome-variable chosen by researchers to gather information on psychological functioning. If an individual shows competence in developmental tasks, it does not mean the individual has not, for instance, high levels of distress [6]. Furthermore, protective factors can be based on the observed resilience patterns of recovery and sustainability [7]. Research depicts the interdependence between protective factors in reference to these patterns [1]. Additionally, a factor may display a stronger compensation-effect – i.e. an effect that is independent of a risk assessment – as an interaction effect – i.e. an effect emerging from the interaction with special risks [1]. Since adult education cannot generalize on validated protective factors, program developers are facing the challenge of cautiously applying current research findings on confirmed protective factors to the target group, effect, and outcome according to their own interests. Systematic procedures that identify validated factors in their modes of action are required. This study aims to systematically identify validated psychological protective factors in adults that promote healthy mental development despite life-risks. The focus lays on factors that could be integrated into stress prevention programs, as these programs provide a foundation for psychological functioning despite stress.
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Methodology A systematic review was conducted by following guidelines of manuals for systematic reviews and meta-analysis [8] [9].
1.1
Data Sources and Searches
A systematic search of six electronic databases (PubMed, PMC, PsycINFO, PsycNet; ERIC, FIS) was conducted for empirical primary studies measuring protective factors in adults and using quantitative design, published between 1970 and 2013 in English or German. Search terms included resilience [resilien*; risk* (AND) competen*], adulthood [adult*, late adolescen*, lifespan], protective factor [factor*, asset*, resource*] as well as the German variants.
1.2
Study Selection All article titles and abstracts (n= 664) were screened for inclusion. Inclusion criteria consisted of:
a) protective factor: psychological factors that are assumed to have a relational effect as consistent with research status quo; factors that interact with risk and buffer stress b) population: adults aged 18 and older who had at least one stress-inducing risk d) outcome: maintenance of mental functioning, measured only with indicators of psychopathology and/or wellbeing c) study design: cohort studies, case-control studies and cross sectional studies that included a population size over 100 As the review searches purely for factors possibly seen as validated and relevant for discussion of resilience promotion; study result as well as validation of study result are also specified. e) study result: protective factors show a significant positive relationship with outcome f) validation of study result: a minimum two-fold confirmation of protective effects through prospective longitudinal studies measuring comparable constructs of a protective factor and no conflicting results in terms of a comparable construct within the studies Figure 1 illustrates the study screening. Figure 1: Flow diagram showing details of the studies included and excluded in the current review.
1.3
Quality Assessment
To analyze the quality of the selected studies, the review uses adapted criteria from NHS Centre for Reviews and Dissemination [10]. Of the nine criteria, two are left out because they refer to intervention studies. Criteria of internal validity (IV) were:
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IV1: Adequate description of the study participants IV2: Adequate measurement of the independent and dependent variables IV3: Relevance of measures for answering the research question IV4: Drop-out rate in studies following people over time introduced no bias IV5: Study length that allow identification of changes in the outcome of interest IV6: Similarity of groups being compared IV7: Blind outcome assessment to exposure status Although it is considered necessary, the generalization of the results assessed with reference to the individual research subject of a review is rarely specifically examined [8] [11]. It is crucial, particularly for intervention research, to know in which target population the validated factors have an effect. The review focuses on protective factors in populations aged 18 and older, which have at least one stress-inducing risk. Thus, it was important to assess, whether study results can be projected on this population, by assessing the following criteria of generalizability (G): G1: Age the individual was when exposed to protective factor G2: Gender G3: Risk-type G4: Risk-level G5: Cultural background
Results 1.1
Included Studies
In total, three prospective longitudinal studies and three cross sectional studies were included. They validate the following protective factors: Perception of personal control, responsibility and socialization. Table 1 illustrates perception of personal control is confirmed by five studies; responsibility and socialization are both confirmed two-fold [4][12]. Comparability of the measured constructs was given. Table 1: Studies which match all inclusion criteria ordered by validated factors.
Protective factor Perception Control
of
Study
Study design
Personal Fife et al. (2008)
Cohort study
Responsibility
Socialization
1.2
Werner & Smith (1992)
Cohort study
Alim et al. (2008)
Cross sectional study
Pitzer & Fingerman (2010)
Cross sectional study
Lam & Grossman (1997)
Cross sectional study
Werner & Smith (2001)
Cohort study
Werner & Smith (1992)
Cohort study
Werner & Smith (2001)
Cohort study
Werner & Smith (1992)
Cohort study
Results of Quality Assessment
All of the studies show high internal validity in population description as well as in choosing the measures that address the research question. For the three cross-sectional studies done by Alim and colleagues [1], Lam and Grossman [13], and Pitzer and Fingerman [5], the issue of drop-outs is not relevant. Furthermore, since there is only one measurement point, only correlative relationships are represented. However, as these studies, as well as by two longitudinal studies [4] [14], confirm personal control as a protective factor, a predictive effect on the outcome can be assumed. Although tested reliability and validity of outcome measurement instrument is not apparent in the Werner and Smith studies [4][12], these two studies are particularly characterized by a strong internal validity in terms of the other criteria. Both studies confirm many years of stable development of mental functioning in the face of risk effects. Personal control is confirmed to
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predict fourteen years of stable psychological functioning [4] and responsibility and socialization fourteen and twenty-two years respectively [4][12]. Overall, none of the studies has such major shortcomings that it should be excluded from further discussion. Table 2 illustrates the results on generalizability assessment. Table 2: Study information ordered by validation of factors and criteria of generalizability. Protective factor Perception Personal Control
Study
G1
G2
of Fife et al. mean: 50.4 m,f/m, (2008) (range: not f stated (n.s.); SD: 11.5)
and
G4
G5
Care for an ill 1 family member during transplantation phase
Sample of mostly Caucasians; also African Americans, Hispanics, and Native Americans
m,f/m, f
Range of critical 4+ life events, chronic disadvantages
Residents of the Island of Kauai; inter alia, Phillipinos, Chinese, Japanese)
Alim et al. mean: m,f/m, (2008) 42,4 f (range: n.s.; SD:14,9)
Traumatic event 1+ (Unspecified)
Urban sample; African American Culture
Pitzer & mean: m,f/m, Fingerma 47 (range: f n (2010) 25-74; SD: n.s.)
Very severe 1 physical abuse in dichochildhood tomous
n.s.
Lam & mean: 18.8 f/f 17Grossman (range: 46; SD: 2.3) (1997)
Abuse childhood
Werner & 18 Smith (1992)
Sociali-zation
G3
in 1 dicho- Students at a large tomous Northeastern university; African Americans, Asian Americans, Hispanics, Caucasians; religion: inter alia Catholic, Jewish, Protestant
Werner & 18 Smith (1992)
S: m,f/f
Range of critical 4+ life events, chronic R: m,f/ disadvantages f
Residents of the Island of Kauai (inter alia, Phillipinos; Chinese, Japanese)
Werner & 18 Smith (2001)
S: m,f/m, f R: m,f/f
Residents of the Island of Kauai (inter alia, Phillipinos; Chinese, Japanese)
Respon-sibility
Range of critical 4+ life events, chronic disadvantages
While some studies [4][12][13] focus upon protective factors in young adults, the other studies include a wide range of adult ages. Most of the studies measure protective factors in both genders. Stress-inducing risks are very heterogeneous. From child abuse and its negative long-term consequences [5] to caring for a family member with a serious illness [14], as well as to a range of critical life events, for example a hurricane or growing up poverty stricken [12]. Risk levels differ among the referenced studies from one [14] to at least four and more risk factors [4].The level cannot be quantitatively detected in every case as risk measures sometimes use dichotomous assessments. There is very little comprehensive information about the cultural background of the study samples as most studies focus upon single aspects such as nationality or religion.
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Discussion 1.1
Perception of Personal Control
The review results refer to a protective effect of personal control in young, middle-aged, and older adults. This is underlined by Pitzer and Fingerman [5] who control age in their wide-range age-sample and find no significant discrepancies. This review result somewhat contradicts Hay and Diehl [15] as they show that an internal locus of control is protective in all age-groups, but especially in young adults. Furthermore, personal control seems to be independent of gender. Due to the range of measured risk-types and levels, the studies rather suggest a broad-based protective effect against diverse stress-inducing chronic, or acute risks with short-and long-term effects acting on different risk levels. However, the generalizability of risk type in particular must be evaluated with caution since it is possible that there may be certain kinds of situations in which the individual has no control. A high perception of personal control can then cause more negative psychological effects [16]. When facing the cultural background, only few conclusions can be made about generalizability of the effects in terms of the entire adult population. Looking at the specified nationalities, the protection factor seems particularly validated in Americans [4][1][13]. As also other nationalities and living-worlds are assessed, personal control also portrays a rather generalizing effect when considering cultural background.
1.2
Responsibility and Socialization
The psychological constructs of responsibility and socialization are both validated two-fold by the same studies of Werner and Smith [4][12]. Since the studies confirm the protective factors solely in young adults, conclusions on protective effects cannot be extrapolated onto middle or older aged adults. The results of the studies suggest a stronger effect on women than on men, especially in terms of responsibility. Based on an developmental psychology-argument, the authors suggest that psychological protective factors are particularly significant for women in transitioning to adulthood [4]. The effect of responsibility and socialization is only validated in terms of high-risk individuals; assumptions of an equally protective effect on people facing lower risk levels cannot be made. As the Kauai Study focuses on a range of different risk factors, the interaction-effect seems to be given in adults facing multiple stress-inducing risks. However, the effect of responsibility and socialization in an environment other than that of the island remains unknown.
1.3
Excluded Studies
The excluded studies confirm a factors range from more general and often validated factors, such as emotional control [17][18], active coping [19], self-esteem [20], optimism [21][22], religiosity [23][24], or intelligence [25][18], as well as more specific factors such as Anglo-orientation [19] and self-compassion [26]. The relatively small number of six studies that met all inclusion criteria speaks for the problems identified in the current state of resilience research. Although there are many empirical studies investigating protective factors in adulthood, the studies are extremely heterogeneous, especially in the measured constructs of interest. This may result in a modest validation of a factor when the contingencies of the protective effect are kept to a minimum. While responsibility and socialization were not investigated by any other study within the 664 excluded studies, there is supporting evidence for the positive effect of personal control. However, in this cases a similar but not the same construct is measured [27][15][28] or the relation to solely health-based outcomes [29] is not given. Adult education cannot disregard these contingencies when aiming to identify validated factors for special target groups that make a specific promotion-outcome likely.
1.4
Limitations
Only one reviewer conducted the review. Another limitation is leaving out a view on generalizability of socio-economic status as well as a differentiation between well-being and psychopathology.
Conclusion and Future Directions The review shows that adult related resilience research provides reasonable indications of personal control, responsibility, and socialization as being psychologically protective factors that buffer the negative effect of a variety of stress-inducing risks and predict the maintenance of mental health. It is relevant to discuss them in the context of prevention programs. However, all of the three factors need further conformance by empirical research. Further research should discuss the relatively but not absolutely stable personality factors in their plasticity through adult educational measures.
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References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23]
Alim, T., Feder, A., Graves, R., Wang, Y., Weaver, J., Westphal, M., Doucette, J., Mellman, T., Lawsen, W. & Charney, D. 2008. Trauma, Resilience and Recovery in a High-Risk AfricanAmerican Population. American Journal of Psychiatry 165(12), pp. 1566–1575. Greenfield, E. A.; Marks, N. F. 2010. Sense of Community as a Protective Factor against Long‐Term Psychological Effects of Childhood Violence. Social Service Review 84(1), pp.129– 147. Vanderbilt-Adriance, E. & Shaw, D. S. 2008. Conceptualizing and Re-Evaluating Resilience Across Levels of Risk, Time, and Domains of Competence. In: Clinical Child and Familiy Psychology Review 11 (1-2), pp. 30–58. Werner, E. & Smith, R. 1992. Overcoming the Odds. High Risk Children From Birth to Adulthood. Ithaca, London: Cornell University Press. Pitzer, L. M. & Fingerman, K. L. 2010. Psychosocial Resources and Associations Between Childhood Physical Abuse and Adult Well-being. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 65B (4), pp. 425–433. Luthar, S. S. 1993. Annotation: Methodological and Conceptual Issues in Research on Childhood Resilience. Journal of Child Psychology and Psychiatry 34 (4), pp. 441–453. Reich, J. W. Zautra, A. J. &. Hall, J. S. (Ed.). 2010. Handbook of Adult Resilience. New York, London: The Guilford Press. Petticrew, M. & Roberts, H. 2006. Systematic Reviews in the Social Sciences. A Practical Guide. Malden, MA, Oxford: Blackwell Pub. Kunz, R., Khan, K. S., Kleijnen, J. & Antes, G. 2009. Systematische Übersichtsarbeiten und Meta-Analysen. Einführung in Instrumente der evidenzbasierten Medizin für Ärzte, klinische Forscher und Experten im Gesundheitswesen. (2nd Ed.) Bern: Huber. NHS Centre for Reviews and Dissemination. 2009. Systematic Reviews. CRD's Guidance For Undertaking Reviews in Health Care, retrieved from www.york.ac.uk/inst/crd/pdf/Systematic_Reviews.pdf. Wang, S. 2005. Applicability and Transferability of Interventions in Evidence-Based Public Health. Health Promotion International 21(1), pp. 76–83. Werner, E. E. & Smith, R. 2001. Journeys from Childhood to Midlife. Risk, Resilience and Recovery (Ithaca, N.Y: Cornell University Press. Lam, J. N., Grossman, F. K. 1997. Resiliency and Adult Adaptation in Women with And without Self-Reported Histories of Childhood Sexual Abuse. Journal of Trauma and Stress 10(2), pp. 175–196. Fife, B. L., Monahan, P. O., Abonour, R., Wood, L. L., Stump, T. E. 2008. Adaptation of Family Caregivers During The Acute Phase of Adult BMT. Bone Marrow Transplant 43(12), pp. 959– 966. Diehl, M. & Hay, E. L. 2010. Risk and Resilience Factors in Coping With Daily Stress in Adulthood: The Role of Age, Self-Concept Incoherence, and Personal Control. Developmental Psychology 46(5), pp. 1132–1146. Heckhausen, J. & Heckhausen H. 2005. Motivation und Handeln. (3. Ed.). Berlin: Springer. Stenbacka, M. 2000. The Role of Competence Factors in Reducing the Future Risk of Drug Use Among Young Swedish Men. Addiction 95(10), pp. 1573–1581. Stenbacka, M. & Leifman, A. 2001. Can Individual Competence Factors Prevent Adult Substance and Alcohol Abuse in Low- and High-Income Areas? Alcohol 25(2), pp. 107–114. Torres, L. 2010. Predicting Levels of Latino Depression: Acculturation, Acculturative Stress, and Coping. Cultural Diversity and Ethnic Minority Psychology 16(2), pp. 256–263. Updegraff, K. A., Perez-Brena, N. J., Umaña-Taylor, A. J., Jahromi, L. B. & Harvey-Mendoza, E. C. 2013. Mothers’ Trajectories of Depressive Symptoms Across Mexican-Origin Adolescent Daughters’ Transition to Parenthood. Journal of Family Psychology 27(3), pp. 376–386. Moody, C. & Smith, N. G. 2013. Suicide Protective Factors Among Trans Adults. Archives of Sexual Behaviour 42(5), pp. 739–752. Bowling, A. & Iliffe, S. 2011. Psychological Approach to Successful Ageing Predicts Future Quality of Life in Older Adults. Health Quality of Life Outcomes 9(1), p. 13. [23] White, H. R., McMorris, B. J., Catalano, R. F., Fleming, C. B., Haggerty, K P. & Abbot, R. D. 2006. Increases in Alcohol and Marijuana Use During the Transition Out of High School Into
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[24] [25] [26] [27] [28] [29]
Emerging Adulthood: The Effects of Leaving Home, Going to College, and High School Protective Factors. In: Journal of Studies on Alcohol and Drugs 67(6), pp. 810–822. Krause, N. 2003. Religious Meaning and Subjective Well-Being in Late Life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58(3), p. 160-170. Masten, A S., Burt, K. B., Roisman, G. I., Obradović, J., Long, J. D.; Tellegen, A. 2004. Resources and Resilience in the Transition to Adulthood: Continuity and Change. Developmental Psychopatholy 16(4), pp. 1071–1094. Sbarra, D. A., Smith, H. L. & Mehl, M. R. 2012. When Leaving Your Ex, Love Yourself: Observational Ratings of Self-Compassion Predict The Course of Emotional Recovery Following Marital Separation. Psychological Science 23(3), pp. 261–269. Hobfoll, S. E., Mancini, A. D., Hall, Brian J., Canetti, D., Bonanno, G. A. 2011. The Limits of Resilience: Distress Following Chronic Political Violence Among Palestinians. Social Science & Medicine 72(8), pp. 1400–1408. Hay, E. L., Diehl, M. 2010. Reactivity to Daily Stressors in Adulthood: The Importance of Stressor Type in Characterizing Risk Factors. Psychology and Aging 25(1), pp. 118–131. Rönkä, A., Oravala, S. & Pulkkinen, L. 2002. “I Met this Wife of Mine and Things Got Onto a Better Track" Turning Points in Risk Development. Journal of Adolescence 25(1), pp. 47–63.
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Vocational recovery in first-episode psychosis Ienciu M.1, Romosan F.1, Bredicean C.1, Cristanovici M.2, Hurmuz M.2 1Victor Babes University of Medicine and Pharmacy Timisoara (ROMANIA) 2”Eduard Pamfil” Psychiatric Clinic Timisoara (ROMANIA)
[email protected],
[email protected],
[email protected],
[email protected],
[email protected]
Abstract Introduction. Resumption of the vocational activity is an important sector when considering the management of first-episode psychosis and the overall process of recovery. In clinical practice this goal is not always easily attainable. Objectives. To assess the vocational status after the first-episode psychosis, along with the difficulties related to resuming professional activities and the potential clinical correlations that might have an impact on this issue. Method. A total of 59 patients with a first-episode psychosis in 2012 were included in the study. We analyzed the demographic data (gender, education, type of work at their last job, working hours previous to the episode, financial satisfaction, own family existence, independence from parents), clinical data (age at onset, diagnostic according to the ICD 10). There was a follow-up at 12 months, which served to analyze the professional situation, as well as to test any potential reintegration difficulties. Results. Job loss after a first-episode psychosis is a common occurrence. Resumption of the vocational activity and the related difficulties depend on: the type of diagnosis, presence of cognitive symptoms, the existence of psychotropic medication side effects, family induced stress, financial needs. Conclusions. Vocational reinstatement after a first-episode psychosis is an important element that the clinician should consider during the overall process of recovery of patients with a first-episode psychosis. In addition to clinical monitoring and of medication side effects, counseling interventions for patients and their families are required, as well as interventions at the workplace. Keywords: psychosis, vocational recovery, employers, counseling
Introduction The first episode psychosis is an important event in a person's life because of the symptoms, the need for hospitalization but also the need for medical treatment. Thus, it represents a factor that influences many aspects of daily life including: employment and financial stability. Furthermore, the onset of the disease is usually placed in the chrono-biological stage of young adult when a person is about to find a way of life and a professional trajectory. The disease affects on one hand the skills related to job performance, their competitive aspects, the capacity to cope with various stressors and on the other hand problems arise regarding saving self-esteem, worthlessness and stigma related to mental illness, situation that is extremely common [1]. One of the things that are now a harsh reality: in good economic times subjects with schizophrenia are the last to be employed and during the economic downturns they are the first to be fired [2]. Resumption of professional activity of a person who has experienced a psychotic disorder should be a priority in the process of recovery [3]. Resumption of professional activity is influenced by the patient's ability to negotiate, but also by the employer’s acceptance [4].
Objectives The study aims to assess the professional situation and the difficulties related to the resumption of professional activity after a first episode psychosis.
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Method The study sample consisted of 59 subjects who had a first episode of psychosis in 2012 and have been selected based on inclusion/exclusion, without using statistical methodology. Inclusion criteria: 1. first episode of psychosis was in 2012 and required hospitalization in Timisoara Psychiatric Clinic 2. diagnosis established according to ICD-10 criteria 3. subjects are active outpatients of Timisoara Clinical Ambulatory 4.subjects agree to participate in the study Exclusion criteria: 1. presence of personality disorders or mental retardation 2. presence of organic pathology or caused by substance abuse The following parameters were analyzed at the onset: - socio-demographic ( gender, age at onset , educational level, family status , professional status) - clinical (diagnosis at onset, duration of untreated psychosis) After a year of evolution we found 25 subjects as active outpatients in clinical ambulatory and we assessed them on their current professional status and they also responded to a questionnaire regarding this issue. The questionnaire has been created by us and contained questions about: professional activity, financial satisfaction and factors correlated with professional integration difficulties. We mention that the questionnaire was applied to all the 25 subjects in order to assess their expectations from their professional activity. Given the small number of subjects, a qualitative analysis of the data was performed.
Results The sample we assessed in 2013 comprised only 25 subjects (42.3%). As regards the rest of the subjects from the initial sample, we couldn’t find current information on them since they stopped presenting monthly in the clinical ambulatory. Table 1. Socio-demographic and clinical data
Subjects Gender Male Female Average age at onset Average education period Family status Married Single Divorced Widow Duration of untreated psychosis Clinical diagnosis at onset (ICD 10) F20 F22 F23 F28 F30 F32
32% 68% 37,5 years 11,04 years 48% 32% 12% 8% 125 days 4% 24% 28% 28% 8% 8%
F20-schizophrenia , F22- persistent delusional disorder, F23- acute and transient psychotic disorder, F28 other types of non-organic psychoses, F30 manic episode with psychotic symptoms, F32 depressive episode with psychotic symptoms Current professional situation was analyzed after a year of evolution and compared with the one at onset and is presented in Figure 1.
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Figure 1. Professional situation present/onset
The questionnaire we applied contains more items and a part of the results we obtained are summarized in Table II. Table 2. Questionnaire results
Questionnaire Professional performance Satisfactory Unsatisfactory Financial satisfaction Present Absent Factors to influence professional life Remission of the disease Society support Family support
Subjects (%) 76% 24% 16% 84% 60% 20% 20%
Discussions The term "recovery" should be understood as an active process in an ongoing dynamic that involves much more than simply "the return to the original state of normality". Illness should be understood also from a psychopathological perspective as an experienced life event, the important issue being the regain of the safety and control in the patient’s personal life. Recovery means a life lived with purpose, meaning and even wealthy, along with the symptoms. Recovery means gaining wisdom and the capacity to extract positive aspects even from the negative events. The issue is not between healthy or sick, but healthy and sick at the same time. Job loss after a first episode psychosis is a common situation. Resumption of professional activity and the related difficulties depend on: the type of diagnosis, the presence of cognitive symptoms, coping difficulties, stigma, side effects of psychiatric medication, family pressure and financial needs. Analyzing professional evolution a year after a first episode psychosis we observed the following dynamics: - Of the 9 subjects who were employed only 6 have kept their workplace, 2 subjects retired due to mental illness and one of the subjects who had no job at onset is currently employed - The number of retires subjects is higher at present since at onset the sample included 4 subjects that were already retired due to somatic illness to which, after an year, 6 other subjects retired due to mental illness were added;
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- Of the 11 subjects that were unemployed at onset, only 4 of them remained unemployed, 6 retired and 1 is currently employed It can be seen that most subjects who had a job were able to maintain it. This is favorable for the course of the disease because maintaining vocational functioning is one of the factors of protection. The questionnaire was filled in by all of the subjects we have found as active outpatients after an year of evolution. The results show that the majority are satisfied with their current professional status even though they are retired on medical reasons which outlines the low expectations they have in relation to the professional activity. In terms of financial satisfaction, this is low even for those who work. To increase the professional level most subjects see healing as a possible solution and fewer subjects count on help from family or social programs. After a first episode of psychosis in addition to clinical monitoring, counselling interventions for patients, families , and interventions at work are needed( negotiating with the employer, the identification of new professional skills , fight stigma). Professional functional outcome is as equally important as clinical symptomatic outcome. In the scientific literature the percentage of people that are unemployed after a first episode psychosis is 40-50%, but it can rise to 75%, which is actually a dramatic situation [5]. The status of being an employee is an important element in managing symptoms and preventing relapse and also is a factor of social validation and strengthening of self-esteem. In order to achieve a proper professional performance the following are need: a graded and flexible program, the acceptance of abilities and performances lower than professional requirements, the restructuring of everyday life, interpersonal empathy and acceptance, acceptance of limitations from the patients (including financial), new priorities for professional life (see focusing on wellbeing), training for employers to improve their visions of patients with first episode psychosis. The limitations of this study are represented by the small number of subjects due to the restrictive inclusion criteria. It is necessary that the period for the inclusion in the study is longer, of approximately 3 years in order to increase the number of subjects.
Conclusions - Professional functioning after a first episode psychosis is influenced by the disease but also by the functioning prior to the psychotic episode - Decline in social functioning is common after an episode of psychosis - Interventions for rehabilitation and for increasing resilience are needed for subjects with first episode psychosis - Rehabilitation programs carried with employers and society are also important and needed.
References [1] [2] [3] [4] [5]
Waghorn, G., Chant, D., Whiteford, H. (2003). The strenght of self-reported course of illness in predicting vocational recovery for patients with schizophrenia. Journal of Vocational Rehabilitation 18, pp. 33-41. Warner, R. (1986). Hard times and schizophrenia. Psychology today 20, pp. 50-52. Woodside, H., Krupa, T., Pocock, K. (2007). Early psychosis activity performance and social participation: a concept model to guide rehabilitation and recovery in early psychosis. Psych Rehab J 31, pp.125-30. Woodside, H., Krupa, T., Pocock, K. (2008). How people negotiate for success when psychosis emerges. Early Intervention Psychiatry 2, pp. 50-54. Marwasha, S., Johnson, S. (2004). Schizophrenia and employment: a review. Soc Psychiatry Psychiatr Epidemiol 39, pp. 337-349.
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The inanimate object as a protective factor in the process of resilience Ionescu S.1, Boucon V.2 1
Professeur émérite Université Paris 8 Saint-Denis et Université du Québec à Trois-Rivières Psychologue clinicienne, doctorante en psychologie Université Paris 8 (France)
[email protected],
[email protected] 2
Abstract Protective factors involved in the resilience process are usually classified as individual, family-related and environmental. To our knowledge no publication refers to the protective property of inanimate objects. This research, conducted at the Reunion Island, on 120 university students, aims to answer the following three questions: (1) is the possession of amulet-like objects frequent in such a population? (2) What protect these objects? (3) From what are they protecting? The results show that 35 % of participants have an amulet-like object. Objects serve primarily to protect the holder from «malicious» persons, from what can motivate these persons or from means used by these people. Keywords: Resilience, inanimate objects, protective factors, university students, Reunion Island
Introduction Conçue actuellement comme un processus, la résilience se construit dans le cadre de l’interaction entre les facteurs de risque auxquels est exposée une personne et les facteurs de protection dont elle bénéficie [1-2]. Sur cette base, plusieurs propositions de modélisation du processus de résilience ont été avancées. Si au départ Garmezy, Masten et Tellegen [3] ont proposé trois modèles – compensation, défi et protection – d’autres modèles ont été décrits et testés par la suite [4, par exemple]. Les facteurs de risque et de protection impliqués dans le processus de résilience peuvent être individuels, familiaux et environnementaux [5]. À notre connaissance, aucune publication n’a été jusqu’à présent consacrée aux objets inanimés en tant que facteurs de protection pouvant participer au processus de résilience. Par contre, il existe depuis la première moitié du 20ème siècle de nombreux travaux ethnographiques, anthropologiques ou historiques concernant les amulettes, talismans ou porte-bonheurs [6-10, par exemple]. Quelques travaux, seulement, ont été réalisés dans une perspective clinique, les objets de type «amulette », y étant présentés comme des objets «de soutien» [11-12], des outils thérapeutiques [13-15] ou des «promoteurs» d’auto-efficacité et d’optimisme [16]. Des observations préalables [17] nous ont montré la présence relativement importante d’objets de protection, appelés protéksyon, méday ou garanti à l’Île de la Réunion. Nous avions alors observé plusieurs dispositifs thérapeutiques traditionnels au cours desquels des garantis étaient fabriqués et prescrits par des tradipraticiens. La présente communication vise à répondre, à partir des données recueillies sur une population d’étudiants d’université réunionnais, aux trois questions suivantes : (1) dans cette population, la possession de tels objets est-elle fréquente? (2) que protègent ces objets ? (3) de quoi protègent-ils? Elle constitue une partie d’un travail doctoral plus ample consacré aux objets comme facteurs de protection intervenant dans le processus de résilience.
Méthode L’étude a été menée auprès de quatre groupes à effectifs égaux (N=30), composés d’étudiants d’université. Les groupes se différencient par le genre et les programmes universitaires dans lesquels les sujets sont inscrits : étudiantes en sciences humaines (groupe 1) et en sciences (groupe 2), étudiants en sciences humaines (groupe 3) et en sciences (groupe 4). Les participants sont âgés de 18 à 29 ans (moyenne de 21 ans et 4 mois; écart-type de 2,29). Les participants à l’étude ont répondu à un questionnaire qui leur a été proposé en français et en créole réunionnais. Les trois questions mentionnées ci-dessus faisaient partie de ce questionnaire.
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Résultats Les résultats obtenus montrent que 42 étudiants (soit 35 % des 120 participants à l’étude) possèdent un objet de protection. Ce pourcentage est inférieur à celui mis en évidence par Arakawa et Murukami [9] qui, dans une étude menée auprès d’étudiants japonais (75 hommes et 123 femmes), montraient que 60,6% d’entre eux étaient porteurs d’amulettes. Sur l’ensemble de la population étudiée, le taux de possession d’objets de protection est moins élevé chez les hommes (30 %) que chez les femmes (40 %). L’influence du type d’études sur la possession n’est pas significative pour l’ensemble des étudiants. Cependant, pour les étudiants en sciences, le genre influence la possession de tels objets (p = .046), cinq hommes par rapport à douze femmes étudiant en sciences possèdent des objets protecteurs ; en sciences humaines la différence n’est pas significative. Nous notons que, chez les femmes, le cursus universitaire suivi n’a pas d’influence sur la fréquence de possession de ces objets : elles sont 12 sur 30 à en posséder aussi bien en sciences humaines qu’en sciences. Par contre, les hommes en sciences humaines possèdent plus d’objets de protection que ceux qui étudient en sciences (13/5). Les participants à cette étude possédant de tels objets le font, en premier lieu, pour se protéger euxmêmes ; ils sont 39 sur 42 (soit 92,8 %) à valider cette proposition. Ce constat nous indique un lien étroit entre le sujet et l’objet protecteur. En même temps, nous avons noté, pour cet aspect, l’absence de différence significative entre les groupes aussi bien en fonction du cursus suivi que du genre. En deuxième lieu, le bénéficiaire de la protection est l’habitat (chez 40,4 8% des possesseurs d’objets). Il n’y a pas de différence significative entre les groupes par rapport au cursus suivi. Si 50% des hommes utilisent une protection pour leur domicile, les femmes ne sont que 33,33% à en utiliser. Le véhicule apparaît en troisième position avec 30,95 % des participants usant d’une amulette. Dans ce cas, il n’y a pas de différence significative ni en fonction du genre ni en fonction du cursus suivi. Notons, toutefois, que l’étude ne permet pas de connaître, parmi les participants, le nombre de ceux qui possèdent un véhicule. La cour de la maison est évoquée par 7,14 % des participants comme constituant la quatrième cible de la protection apportée par l’objet. Ces réponses concernent deux hommes – l’un en sciences, l’autre en sciences humaines – et une femme en sciences. La famille est également évoquée à 3 reprises, par des femmes uniquement : deux en sciences et une en sciences humaines. Par famille, il faut considérer uniquement les adultes de la famille puisqu’aucun participant n’a d’enfant. Notons, enfin, des réponses données seulement par un répondant : «les proches» (autres que la famille) sont évoqués par une étudiante en sciences humaines, «l’entourage» par un étudiant en sciences humaines et «un ami» par une étudiante en sciences. Enfin, lorsque nous cherchons à identifier contre quoi les participants estiment avoir besoin de se protéger, nous constatons qu’il s’agit, en premier lieu (64,28% des réponses), de personnes «malintentionnées» (2 réponses), des «autres» (2), des «méchants» (1) de «mauvaises présences» (1), de ce qui peut animer ces personnes, comme la «jalousie» (2 réponses) et la «méchanceté» (1) ou enfin, des moyens utilisés par ces personnes, comme les «mauvais esprits» (5 réponses), les «mauvais regards» (4), les «mauvaises pensées» (3), le «mauvais œil» (2), les «mauvais sorts» (2), les «mauvais coups» (1), les «mauvaises intentions» (1). La deuxième menace évoquée nécessitant une protection (correspondant à 35,71% des réponses) est l’adversité en général, plus précisément le «malheur» (4 réponses) et le «mal» (11). Les accidents viennent en troisième position (avec 11,9% des réponses, soit cinq étudiants).
Conclusion Les résultats obtenus montrent qu’un peu plus d’un participant sur trois possède un objet de type «amulette». L’influence du type d’études sur la possession n’est pas significative pour l’ensemble des étudiants. Cependant, pour les étudiants en sciences, le genre influence la possession de tels objets (cinq hommes/douze femmes étudiant en sciences possèdent des objets protecteurs) ; en sciences humaines, par contre, aucune différence n’est observée en relation avec le genre. Nous notons que chez les femmes le cursus universitaire suivi n’a pas d’influence sur la fréquence de possession de ces objets. Par contre, les hommes en sciences humaines possèdent plus d’objets de protection que ceux qui étudient en sciences. Les objets servent en priorité à protéger le détenteur des «autres». Le volet suivant de cette recherche, actuellement en cours, concerne notamment les mécanismes par lesquels les différents objets exercent leur rôle de facteurs de protection.
Bibliographie [1]
Ionescu, S. (2010). Du pathocentrisme à la salutogenèse : apports du concept de résilience. In S. Ionescu, Psychopathologie de l’adulte. Fondements et perspectives. Paris : Belin, pp. 271-297
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[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]
Ionescu, S. (2011). Le domaine de la résilience assistée. In S. Ionescu (dir.), Traité de résilience assistée. Paris : PUF, pp.3-18. Garmezy, N., Masten, A.S. & Tellegen, A. (1984). The study of stress and competence in children: A building block for developmental psychopathology. Child Development, 55, 97-111. Brook, J.S., Brook, D.W., Gordon, A.S., & Whiteman, M. (1990). The psychosocial etiology of adolescent drug use: A family interactional approach. Genetic, Social, and General Psychology Monographs, 113, 125-143. Maste, A.S., & Coatsworth, J.D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53, 205-220. Grendon, F. (1909). The anglo-saxon charms. The Journal of American Folklore, XXII (84), 105-237. Hildburgh, W.L. (1915). Notes on some Japanese Coins and Coin-like Objects used as amulets and in charms. Man, 15, 56-59. Hildburgh, W.L. (1918). Some Japanese charms connected with earthquakes. Man, 18, 57-59. Hildburgh, W.L. (1919). Note on the gourd as an amulet en Japan. Man, 19, 25-29. Roberts, H. (1932). Amulets and superstitions. Psychological Bulletin, 29(5), 373-375. Arakawa, A. & Murakami, K. (2006). Les fonctions du port d’amulette : observation des relations entre donateur et récipiendaire (en japonais). Le journal japonais de psychologie sociale, 22(1), 85-97. Barr J., Berkovitch, M., Matras, H., Kocer, E., Greenberg, R. & Eshel, G. (2000). Talisman and Amulets in the pediatric intensive Care Unit: Legendary Powers in Contemporary Medecine. The Israel Medical Association Journal, 2, 278-281. Nathan, T. (1994). L’influence qui guérit. Paris: Editions Odile Jacob, pp. 308-317. Stevenson, R.G. (1994). Dragons as amulets, dragons as talismans, dragons as counselors. Death Studies, 18(3), pp. 219-228. Talaban, I. (2002). Le bol de la grand-mère. Psychologie française, 47(4), 15-24. Wiseman, R. & Watt, C. (2004). Measuring superstitions belief: Why lucky charms matter. Personality and Individual Differences, 37(8), pp. 1533-1541. Boucon, V. (2005). Les garantis : objets à la croisée des chemins entre monde profane et monde sacré. Mémoire de maîtrise de psychologie clinique. Université Paris 8.
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Impact of personality spiritual dimensions on quality of life and resilience Manea Minodora M.1, Cosman Doina M.C.1, Lazărescu Mircea D.2 1 Department of Clinical Psychology, Department of Psychiatry , University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, (ROMANIA) 2 Department of Psychiatry, University of Medicine and Pharmacy "Victor Babes", Timisoara (ROMANIA)
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Abstract Self-transcendence is considered the landmark of spirituality in the structure of human personality. Selftranscendence can be defined as a high rank multifaceted descriptor, formed of the following inferior rank traits : Creative self-forgetful vs. Conscious individual experience, Transpersonal identification vs. Individual identification, Spiritual acceptance vs. Rational materialism. Objectives: In an attempt to study the impact of personality factors on quality of life and personal resilience, personality resistence to stress and the role of personality dimensions in triggering suicidal behavior, we studied a lot of 131 patients diagnosed with personality disorder. Results and discussion: By analyzing the correlations between the values obtained by the subjects in personality dimension tests and the scores they obtained on a scale of life quality – Multicultural Quality of Life Index (MCQL), we found significant correlations between the scores obtained for Self-transcendence and the scores for the quality of life. Conclusion: Our study proved that patients with low self-transcendence scores manifest a decrease in quality of life, were less resilient and manifested a suicidal behavior. Keywords: person, personality, self-transcendence, spirituality, quality of life, resilience .
Introduction The concept of personality is an operational concept belonging to general psychology while the concept of person designates the unique human being, aware of himself/ herself as personal identity and existence in relation to the world. The concept of person is circumscribed to personality and has self-transcendence in its structure as central dimension. [1]. The analysis of self-transcendence as belonging to the person /human personality opens the door to selfknowledge in personology. At the same time Self-transcendence is considered the landmark of spirituality in the structure of human personality. Self-knowledge as a high moral duty was inaugurated in history by Socrates’ “Daimonion” and seemed to end with Freud’s "Unconscious". After Freud the concept of "self-knowledge" was not particularly addressed by psychologists/ psychiatrists and it became more of the psychotherapists’ duty to invite their patients to self-discovery during the therapeutic process. [2]. Robert Cloninger is a particular researcher who stated that full assessment of the individual includes a moral and spiritual dimension involving deep self-knowledge, in the absence of which a person’s subjective well-being is not possible. Thus in Cloninger's vision self-transcendence is a character dimension, the 7-th personality dimension that can be evaluated using the Temperament and Character Inventory. Self-transcendence can be defined as a high rank multifaceted descriptor, formed of the following inferior rank traits: Creative self-bliss vs. Conscious individual experience, Transpersonal identification vs. Individual identification, Spiritual acceptance vs. Rational materialism . [3], [4], [5]
The presence of self-transcendence in personality Self-transcendent people are often described as unpretentious, successful, patient , creative, unselfish, spiritualized . In eastern societies they are described as enlightened and wise, while in western societies the same traits are described as naive.
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Those individuals seem to be able to tolerate ambiguity and uncertainty, they can enjoy most of their actions without feeling pushed to obtain results and without feeling the urge to control them. In fact, many of these people feel that their spiritualization helped them understand the real purpose of life. Self-transcendent people are perceived as humble, modest, accepting failure even after having done their best, satisfied with both failure and success. However, they may be criticized for what is considered in Western society as simplicity, magical thinking, subjective idealism that can interfere with the acquisition of wealth and material power. Self-transcendence has highly adaptive advantages when the individual is facing suffering and death, which are inevitable to appear in life with aging. Thus the spiritual dimension can be considered an important factor in personal resilience, since studies show that individuals with low scores presented a suicidal behavior. At present resiliency is considered the science of mastering life's greatest challenges. [3], [4], [5], [6].
Personology study In an attempt to study the impact of personality factors on quality of life and personal resilience, personality resistence to stress and the role of personality dimensions in triggering suicidal behavior, we studied a lot of 131 patients diagnosed with personality disorder.
Sociodemographic characteristics of the study sample A total of 131 patients with personality disorder, aged between 19 and 62 years (average = 34.13 years, standard deviation (SD) = 9.51) were included in the study.
Specific objective of the study Evaluation of the relationships between the values obtained for personality dimensions and those for quality of life . Research instruments • Temperament and Character Inventory – TCI • Multicultural Quality of Life Index - MQLI. [7]. Multicultural Quality of Life Index (MCQL) Quality of life is defined as a subjective psychological dimension. MCQL is an effective culturally adapted tool. It consists of 10 items, corresponding to some widely recognized dimensions of the quality of life concept. The items include: • psychological / emotional well-being ; • independent occupational and interpersonal functioning ; • emotional and community support ; • personal and spiritual fulfillment ; • overall perception of quality of life. Each item is rated on a scale of 10 points, from poor to excellent. [7].
Results and discussion : Significant correlations were found in the size of character Autotranscendenta the Multicultural Quality of Life Index . Significant correlations were found between Self-transcendence and Multicultural Quality of Life Index.
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Figure 1. The correlation between the scores obtained by the subjects at Self-transcendence and the scores on scale MCQL.
Thus according to that correlation analysis, 3.5% (r ² = 0.035 ) of the variation in quality of life scale is due to the score variation on Self-transcendence dimension scale. Our study proved that patients with low self-transcendence scores were less resilient and manifested a suicidal behavior with conotation of iresilient behavior. Many people turn to religion or spirituality as a way to cope with personal adversity. [7]. Some find solace in formal religious services, while others seek inspiration and strength through private spiritual practices, only if they had the self- transcedence in medium through high scores and this personality dimension help them to connect to God or to find their place in the universe. [8].
Conclusions 1. Analysis of self-transcendence dimension as belonging to human personality opens the door to self-knowledge in personology. 2. Few researchers include nowadays the analysis of a person’s spiritual dimensions when assessing his/her personality. 3. Human personality directly influences the scores on scales of quality of life, mainly by character dimensions.
References [1] [2] [3] [4] [5] [6] [7] [8] [9]
Lăzărescu Mircea, Nireştean Aurel.(2007). Tulburările de personalitate –10.Condiţiile comorbide ale tulburărilor de personalitate. Editura Polirom, Iaşi. pp:216-251; 252-268; 282-303. Enăchescu C. (2006). Experiența vieții interioare și cunoașterea de sine (de la Socrate la Freud). Paideia, București, pp 25-35. Cloninger CR, Przybeck TR, Svrakic DM, et al. (1994). The Temperament and Character Inventory (TCI): A guide to Its Development and Use. St. Louis, MO, Center for Psychobiology of Personality, Washington University. Cloninger CR. (2000). A practical way to diagnose personality disorder: A proposal. Journal of Personality Disorders.(14) pp:99–106. Cloninger CR, Svrakic DM, Pryzbeck TR. (1993): A psychobiological model of temperament and characters. Archives of General Psychiatry. (50) pp:975-990. Cloninger CR.(2004) Feeling Good. The Science of Well-Being. Oxford University Press; pp 112-123; 167-183. Mezzich JE, Ruiperez MA, Perez C, Yoon G, Lin J, Mahmud S. (2000) The Spanish version of the Quality of Life Index: presentation and validation, J. Nerv Ment Dis.188(5) pp:301-305. Ionescu S. (2013).Tratat de rezilienta asistata, Editura Trei, pp 41-79 Steven M Southwick; Dennis S.Charney. (2012) Resilience –The science of mastering life’s greatest challenges. Cambridge University Press, pp.81-99.
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The symptom as resilience Robin D. Equipe de recherche CRPC –CLCS [EA4050] France
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Abstract The concept of resilience is used to describe the process that, in the face of adversity, trauma or stress, individuals, families, groups of people are faring not have psychological problems and continue to live like before viewing better than before. The term resilience is often associated with the notion of material success, emotional or social which is to say, tends to designate a psycho-social fact. But it appears that resilience can take forms less positively connoted by the society. Thus certain subjects that are psychologically suffering try to improve their lives by creating a symptom that allows them to complain to others, to numerous requests to specialists or their relatives, to be heard and recognized in their singularity and gives them the feeling of existence. The symptom appears as an invention, a creation of the subject to overcome the anxieties and fears that arise whenever the unexpected and abroad occurs. Clinical psychologist or psychoanalyst allow him to be heard in the depths of his being without judgment and will allow him to be part of a process of re-subjectivation. Resilience could then designate by the effect of this intrapsychic work of the subject who can take place only from a meeting that Freud referred to as "transfer" and psychoanalytic work and would aim to create the conditions for resilience. From clinical cases this is the link between transfer and resilience that will be questioned. Key words: transfer, unconscious, symptom, resilience
A la lecture des nombreux travaux et écrits concernant le concept de «résilience » et à partir de ma pratique en tant que psychologue clinicienne orientée par la psychanalyse il m’apparaît que cette notion pourrait s’appliquer à celle de « symptôme » dans son acception psychanalytique c’est-à-dire comme invention, création du sujet destinée à surmonter les angoisses et les peurs qui surgissent à chaque fois que survient de l’inattendu ou de l’étranger. Cette conception du symptôme comme une production, une substitution à un évènement appréhendé à l’origine comme inassimilable et comme tel refoulé, substitut à une satisfaction pulsionnelle qui n’a pas eu lieu, qui n’a pas pu se satisfaire, ayant le même statut que celui du rêve, du mot d’esprit et du lapsus, a été décrite par FREUD [1] comme formation de compromis, parole d’une vérité que FREUD reconnaîtra comme l’inconscient. LACAN après FREUD ira plus loin en décrivant le symptôme « structuré comme un langage » et non réduit au seul champ du symbolique mais en lien aussi avec l’imaginaire du corps et avec le réel en tant qu’impossible à dire [2]. Ainsi l’angoisse c’est ce qui pénètre du réel dans l’imaginaire c’est-à-dire dans le corps et se traduit par les manifestations physiques telles que le cœur qui bat la chamade, le ventre serré, les jambes qui flageolent…etc. Il ira jusqu’à montrer les effets de création du symptôme [3]. «La résilience n’est pas à rechercher seulement à l’intérieur de la personne, ni dans son entourage mais entre les deux parce qu’elle noue sans cesse un devenir intime avec le devenir social »[5]. Ainsi le symptôme, création originale d’un sujet lui permet-il de se plaindre à d’autres, d’attirer l’attention de son entourage sur lui, d’être reconnu dans sa singularité, d’être écouté, de se sentir exister et peut lui servir d’appui. C’est la rencontre avec un autre mis en position de savoir qui va rendre possible la transformation de la plainte en une demande qui, dans certains cas, va créer de la résilience. Le plus souvent cette rencontre se fait dans ce que FREUD a nommé le «transfert» dans la cure psychanalytique. Le transfert existe dans toute relation basée sur la parole dès lors qu’un savoir est prêté à quelqu’un et peut être défini comme un ensemble de projections, sentiments, pensées, affects, sur la personne « supposée savoir». Ce qui caractérise le transfert, répétition de prototypes infantiles vécus avec un sentiment d’actualité, c’est qu’il permet, par le jeu de la répétition, l’ouverture de l’inconscient. Il est donc la répétition dans le présent d’une relation imaginaire du passé marquée par la confiance et la sécurité. C’est la capacité de neutralité bienveillante du psychanalyste qui va créer l’ambiance nécessaire à son établissement. Carl ROGERS [4] parle de « l’attitude inconditionnelle bienveillante» de l’écoutant comme condition indispensable de la relation d’aide, qui va amener le demandeur d’aide à s’identifier à l’image qui lui est renvoyée pour se trouver aimable et digne d’intérêt. De ce fait il va commencer à croire en
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lui et à faire confiance à ses pensées et ses affects. Aller parler à un analyste institue ce phénomène qui inclut le sujet et l’analyste, le transfert, qui place l’analyste en position de supposé savoir. Ce que pense trouver le névrosé en adressant sa plainte à un psychanalyste c’est l’interprétation de ses symptômes. Il lui suppose un tout savoir sur la cause de ses symptômes. Aller parler à un analyste institue ce phénomène qui inclut le sujet et l’analyste, le transfert qui place l’analyste en position de supposé savoir. Ce que pense trouver le névrosé en adressant sa plainte à un psychanalyste c’est l’interprétation de ses symptômes. Il lui suppose un tout savoir sur la cause de ses symptômes. Boris CYRULNIK décrit trois facteurs déterminants dans la capacité de résilience à savoir la génétique, la stabilité affective des premiers mois et enfin l’école, la famille et la culture. De nombreux exemples cliniques montrent en effet qu’une relation de confiance est en effet plus difficile à instaurer lorsque l’un des partenaires dans la relation a connu une dé privation affective dans les premiers mois de sa vie qui ne lui a pas permis d’acquérir le sentiment de sécurité minimum à l’établissement d’une relation d’objet satisfaisante. Les enfants des rues en Roumanie et dans d’autres pays d’Amérique du sud, d’Afrique et d’Asie en sont le témoignage. Les familles dans lesquelles les liens avec l’extérieur sont très réduits voire inexistants laissent peu d’accès à leurs membres pour une rencontre susceptible de leur permettre de sortir des schémas répétitifs qui se transmettent de génération en génération. Un cas clinique va nous permettre d’apporter un éclairage sur ces assertions. Edouard est un enfant de 9 ans suivi en thérapie depuis quelques mois par une collègue psychologue dans le cadre d’un service de consultation pédopsychiatrique. Il souffre depuis deux ans d’angoisses massives qui l’empêchent de dormir et de se concentrer à l’école. Des comportements bizarres à l’école ont été à l’origine des consultations. Après plusieurs séances au cours desquelles Edouard évoque une «grosse question dont la réponse est dans la famille» sa thérapeute décide de rencontrer les parents pour les adresser vers le centre de thérapie familiale où je travaille. C’est ainsi que je reçois Edouard, sa petite sœur âgée de 7 ans et les parents. Nous nous rencontrerons régulièrement pendant 4 ans. Monsieur et madame se présentent d’emblée comme des parents très préoccupés par leur rôle de parents. Madame a arrêté de travailler à la naissance d’Edouard pour s’occuper des enfants. Monsieur a un métier qui lui permet d’avoir le même rythme que ses enfants scolarisés. A chaque période de vacances scolaires ils partent ensemble dans une autre région de France. Leur vie est organisée autour des enfants. La maison est conçue pour les enfants. Ils voient peu de monde. Madame s’occupe de sa mère, veuve et presqu’aveugle. Monsieur garde des liens avec sa mère assez âgée. Ils n’ont jamais confié leurs enfants à quiconque en dehors de l’école. Edouard présente sa demande. Il a une grosse question dans la gorge (il montre l’emplacement de la question sur son corps) et il sait que la réponse est dans la famille. Ils sont tous d’accord pour aider Edouard. Pendant les premiers entretiens les histoires familiales de monsieur et madame sont déclinées ainsi que la naissance des enfants. Madame est la plus jeune d’une fratrie de deux enfants. Son frère est schizophrène et elle relate une enfance où elle avait le sentiment de ne pas exister à côté d’un frère qui faisait la fierté de sa mère et qui la remplissait, elle, d’effroi. A côté de son frère elle se sentait « pétrifiée » selon ses dires sous le regard de sa mère. Monsieur est fils unique. Sa mère, benjamine d’une fratrie de trois filles, s’est mariée à l’âge de 40 ans pour donner un héritier à la famille, les deux ainées n’ayant pas eu d’enfant. Dès la naissance de monsieur le père de celui-ci a été renvoyé et l’enfant a été élevé par sa grand- mère, sa mère et ses tantes. Il était l’héritier de la famille, l’objet cause du désir de sa mère, sa grand-mère et ses tantes. Il n’y avait pas de place pour le père. A la sixième séance Edouard parvient à verbaliser sa « question » : « Papa, maman est-ce que vous m’avez désiré?», soit la question de l’origine qui touchait au mythe et à l’idéal familial. Les enfants étaient nés du désir de leur mère. Monsieur, quant à lui, ne se sentait pas capable d’être père. Il s’efforçait d’être un père idéal c’està-dire un père sans manque pour ses enfants. C’est ce qu’Edouard avait besoin de questionner. Grâce à la relation transférentielle établie avec sa thérapeute il a pu dans le cadre de la thérapie avec sa famille décompléter l’image du père et se faire une place, ce qui lui a permis de réinvestir le travail en individuel avec sa thérapeute. Quant aux parents d’Edouard ils ont entrepris chacun un travail psychanalytique. Edouard était un enfant psychotique. Suite à ce travail il a pu suivre une scolarité normale jusqu’à l’obtention d’un BEP technique à l’âge de 18 ans. Il a son appartement et le même emploi depuis. La petite sœur, grâce à lui, a grandi sans problème. Elle est mariée et a deux enfants. Le symptôme d’Edouard, parce qu’il a rencontré le désir de sa psychothérapeute dans le transfert, a créé un processus de résilience qui a amené l’arrêt d’une répétition mortifère dans la famille, l’arrêt de ses angoisses destructrices et lui a permis de rebondir d’une position d’enfant porteur de symptôme et voué à devenir «fou» à celle d’un jeune homme qui a pris sa vie en mains. On peut parler de résilience puisqu’il y a bien eu reprise d’un bon développement après un traumatisme, sans retour à l’état initial, et que l’on peut repérer un processus naturel et interactif qui a dépendu autant de l’environnement que du sujet lui-même. Mais ce processus n’a pu se faire que parce qu’il y a eu rencontre à un moment donné, dans le transfert, avec le désir de sa psychothérapeute qui a accueilli sa demande et a été à l’origine de la démarche familiale. C’est donc bien en tant qu’il y a une personne qui est là pour accueillir et entendre ce que dit le symptôme et ce que le sujet a à en dire, en lui permettant de trouver du sens et des signifiants, qu’il pourra y
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avoir un effet de résilience pour le sujet. Ainsi en est-il pour Jean Valjean, le héros de Victor HUGO, dans son roman «Les misérables», après sa rencontre avec l’évêque qui lui fait confiance, le nourrit, lui fait des cadeaux et refuse de l’accuser pour le vol qu’il a commis. La rencontre de cette figure paternelle bienveillante va mettre un terme à sa vie de misérable et de voleur. Par identification à « son sauveur » il va transformer sa vie et devenir à son tour un homme bon et généreux. Son symptôme qui le fait se considérer comme un rebus, un moins que rien et à s’identifier à cette position de déchet, par le traitement qu’en fait l’homme d’église devient facteur de résilience. On pourrait évoquer d’autres cas célèbres où la rencontre d’un signifiant à partir d’un processus d’identification à un autre a été facteur de résilience. La littérature nous donne de nombreux exemples de cas semblables. James JOYCE, l’écrivain anglais, à travers sa rencontre avec l’écriture parvient à se faire un nom là où rien n’avait eu valeur de nomination auparavant. Virginia WOOLF, célèbre auteure du début du 20ème siècle, dont l’œuvre est bâtie sur sa « bataille avec les mots contre une douleur d’existence » qui avait commencé très tôt dans sa vie. « La lecture de son œuvre révèle la tâche infernale à laquelle elle s’est livrée et les moyens qu’elle a trouvés pour se protéger de ce qu’elle nomme son « horreur ». La rencontre avec son mari fut à l’origine de sa production littéraire. Il sut la convaincre de ne pas cesser d’écrire et lui permis, de ce fait, « de se tenir dans le monde » assez longtemps avant que de se suicider. La liste est longue des romanciers et écrivaines, des artistes, des philosophes qui, à partir d’une rencontre avec un homme ou une femme qui a su se mettre à l’écoute de leur symptôme, ont réussi à se tenir dans le monde grâce à leur œuvre.
Références bibliographiques : [1] [2] [3] [4] [5] [6] [7] [8] [9]
FREUD S. (1901) Psychopathologie de la vie quotidienne Petite bibliothèque Payot Paris 2004 LACAN J. (1953) Fonction de la parole et du langage en psychanalyse, Ecrits, Le Seuil, Paris 1966 p. 237-322. LACAN J. (1966) De nos antécédents, Ecrits, Le Seuil Paris p.65-72 ROGERS C. (1971) la relation d’aide et la psychothérapie ESF Editeurs Paris CYRULNIK B. (1999) Un merveilleux malheur Ed. Odile Jacob, Paris HUGO V. (1862) Les Misérables Pocket Paris 2013 JOYCE J. (1901-1932) Œuvres NRF La Pléiade Tome 1 et 2 Paris (1995) LACAN J. (2005) Le Sinthome, Séminaire livre 23 Seuil Paris HARRISON S. ouvrage dirigé par (2011) Virginia Woolf, l’écriture refuge contre la folie, Editions Michèle.
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The role of psychological flexibility for resilience and psychological health Théorêt M.¹, Durand J.C.¹, Sénéchal C.¹, Savoie A.¹, Brunet L.¹, Poirel E.¹, St-Germain M.² 1Université de Montréal, (Québec, Canada) 2Université d’Ottawa, (Ontario, Canada)
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Abstract Health and psychological well-being of educators now represent a concern of psychological research since the advent of a field of study based on stress and teacher burnout. However, out of a traditional approach that tilts towards the adoption of pathological models of work, the study of resilience rather allows for a positive perspective on mental health and its relationship to the work, including education. The fundamental plane of the definition of resilience, we adopt the dynamic person-environment [1], which establishes resilience as a provision to develop context model. We ask more specifically the role of psychological flexibility, a concept that takes shape in psychological theory and psychotherapeutic models. Empirically, this question of the relationship between flexibility and resilience was operationalized through research by electronic questionnaire conducted among schools staff, including 232 in Quebec. Although conceptual analysis may reveal a relationship between resilience and flexibility, this statistical exploration of the role of flexibility for psychological health as well as links between the two concepts seems first to have been conducted with a population non-clinical, in the context of their work. The results show that psychological flexibility may explain part of the resilience of these education professionals as well as several aspects of their health to the work place. These results seem particularly interesting to us on two levels, basic and applied, in that it help to understand a fundamental psychological mechanism of resilience and also help develop practical ways to stimulate its development. Keywords: Resilience, Psychological flexibility, acceptance, emotions, health.
Problématique 1.1
La santé psychologique et la résilience des gestionnaires scolaires
Peut-être en raison des démonstrations de la complexification de la tâche des directions d’établissements scolaires, qui abondent depuis une vingtaine d’années, accompagnées par des indices que ces éducateurs travaillent souvent dans un environnement tumultueux, la recherche sur leur santé psychologique au travail est encore clairsemée, au détriment de celle qui porte sur leur détresse. Le choix d’une telle question relève clairement du paradigme de la résilience au travail. Ainsi vues, les questions du maintien du bien-être et de la santé au travail apparaissent d’autant plus critiques à examiner dans la conjoncture actuelle, où le recrutement et la progression en carrière de ces professionnels demeurent difficile [2]. L’une des raisons qui peut expliquer cette faille relève sans doute de l’envahissement du paradigme du stress dans le champ de la santé psychologique, et en particulier dans celui du travail des professionnels de l’éducation. Il est vrai que plusieurs études abordent indirectement leur santé psychologique à partir d’un point de vue négatif, montrant ainsi qu’ils vivent beaucoup de stress et se sentent souvent dépassés par les contraintes administratives, l’application des réformes et la gestion des conflits interpersonnels [3].
1.2
Les facteurs de la résilience éducationnelle
L’une des premières études qualitatives explorant leur travail d’un point de vue positif à partir de leur résilience suggérait que les directions d’écoles résilientes pourraient s’appuyer sur leurs compétences professionnelles devant l’adversité du travail en milieu défavorisé pour en tirer bénéfice pour eux-mêmes et leur communauté [4] .Dans une enquête menée par voie électronique auprès de directions d’écoles (N=627), Pepe [5] a trouvé une relation positive entre la résilience des directions et leur satisfaction au travail, de même qu’avec
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leur engagement affectif au travail. Cette variable s’exprime par l’alignement du gestionnaire avec la mission et la vision de l’organisation, c’est-à-dire lorsqu’il s’identifie avec les valeurs et les buts de son institution. À elle seule, la variable de l’engagement affectif explique la variance dans la résilience observée chez ces directions d’écoles du primaire et du secondaire. Il nous apparaît dès lors pertinent de questionner les liens entre les variables affectives et la résilience. En tout état de cause, la recherche sur cette fonction administrative semble indiquer que la résilience des gestionnaires scolaires engage bien plus que des compétences professionnelles et organisationnelles, mais émotionnelles aussi, surtout quand ils sont confrontés au stress chronique. De plus, exactement comme chez les enseignants [6], les émotions les plus fréquentes des gestionnaires scolaires sont de valence négative, notamment de colère, de frustration et d’anxiété [4]. En raison de la conception de leur rôle, qui doit les montrer en contrôle de leurs émotions, ils tentent alors de s’ajuster en inhibant leurs émotions négatives[7]. Or, on sait que la suppression des pensées et des émotions négatives produit un effet rebond, très nocif pour la santé [8]. En adoptant la perspective de la résilience et de la santé psychologique au travail, il importe donc de chercher des facteurs de protection plus efficaces que l’inhibition des émotions négatives, pour aider ces professionnels à développer leur résilience, de manière à maintenir leur santé psychologique et leur efficacité au travail.
Cadre théorique Deux modèles théoriques servent à mettre en perspective notre problème de recherche, celui de la résilience établi comme un processus du développement adulte et celui de la flexibilité psychologique, issu de la théorie des cadres relationnels, une théorie du développement du langage et des cognitions appliquée à l’intervention.
1.1
Les dynamiques de la résilience dans le contexte du travail
Plus loin que ses pivots d’adversité et d’adaptation, le concept de résilience n’est certes pas facile à définir, sans doute parce qu’il recouvre plusieurs dimensions et qu’il résulte de divers processus qui se profilent distinctement selon la perspective théorique adoptée [9]). Dans le contexte de la résilience des adultes au travail, on convient généralement que les personnes résilientes sont moins stressées, plus efficaces et en meilleure santé, mais on s’interroge toujours sur les mécanismes responsables de ces adaptations positives à des situations de travail difficiles. On retrace plusieurs mécanismes selon les approches, mais le modèle le plus intégrateur insiste sur trois processus principaux: la récupération de la santé par la diminution des dommages, l’équilibration par la protection de la santé et l’amélioration des habiletés de vie saines et productives par la promotion de la santé [10]. On comprend que ces trois mécanismes s’échelonnent dans le temps, suivant la rencontre de stresseurs avec lesquels l’individu n’arrive pas à composer et qu’ils constituent en tout ou en partie, ce qu’il est convenu de nommer la résilience. Écartelées entre facteurs de risque et de protection, personnels et environnementaux, ces dynamiques qui sous-tendent la résilience mènent de plus à des hypothèses étiologiques variées, selon que l’on considère le phénomène sous l’angle des traits ou sous celui des processus développementaux et qu’on opérationnalise ses mécanismes davantage en termes de résistance aux obstacles, comme la dépression, l’anxiété, le stress, les émotions négatives, ou en termes de développement des forces. En ce qui concerne ces dernières, on reconnaît généralement six grandes catégories de facteurs de protection, qui sont celles de la satisfaction avec la vie, des relations interpersonnelles ou du soutien social, de l’auto-efficacité, de l’estime de soi, de la résolution de problèmes, des émotions positives et de l’optimisme [11]. En questionnant ainsi l’importance relative des liens entre la résilience et la résistance aux obstacles, le développement des forces et les variables de la personne dans l’explication de son développement, une récente méta-analyse [11] a permis d’ordonner statistiquement l’effet de ces trois grandes catégories de facteurs explicatifs de la résilience, en référence à un corpus de recherches regroupant 33 études et plus de 31,000 participants. En termes de prédiction statistique, les chercheurs concluent que la résilience est fortement redevable à l’impact de mécanismes de protection et des facteurs d’autoefficacité et d’émotions positives qui leur sont associés, qu’elle est modérément reliée aux mécanismes de résistance aux obstacles comme le stress et l’anxiété et faiblement redevable aux données démographiques de la personne, comme son âge et son genre. Dit autrement, la résilience se déploierait plus facilement grâce aux facteurs de protection personnels et environnementaux.
1.2
La flexibilité psychologique
Tenant compte de l’importance des facteurs de protection personnels, la synthèse de ces écrits peut nous aiguiller sur la voie de l’auto-contrôle ou de la régulation émotionnelle, ou inversement sur celle de l’acceptation des émotions et des contenus psychologiques négatifs. Dans le premier cas, on tentera de modifier les contenus de pensée et d’émotion alors que dans le second, on les observera sans tenter de les diminuer ou de les supprimer. L’acceptation diffère de l’inhibition et de l’autorégulation, en ce qu’elle amène l’individu à limiter
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l’évitement des événements désagréables pour au contraire, s’y exposer davantage. Elle diffère de la résignation en ce qu’elle amène l’individu à pouvoir évaluer une situation comme négative, sans fonder ses agissements sur ce jugement. L’acceptation sert à augmenter la flexibilité psychologique, qui peut se définir comme un changement radical de perspective sur ce que l’on fait, ce que l’on pense et ce que l’on ressent, dans un sens d’élargissement cognitif plutôt que de restriction cognitive [12]. Elle permet à un individu d’accepter la situation telle qu’elle est, ce qui présente l’avantage de tolérer l’anxiété associée, plutôt que de l’éviter. La flexibilité psychologique offre aussi de considérer des pistes d’action réalistes [13]. Un survivant des camps de concentration exprime magistralement ce que nous définissons comme la flexibilité psychologique. Rapportant un moment où il s’était surpris à être absorbé dans des préoccupations et des inquiétudes autour de ses conditions de vie quotidiennes dans le camp de concentration où il était retenu prisonnier, Frankl [14]) s’exprime ainsi: «J’ai alors orienté mon flot de pensées vers un autre sujet. Soudainement, je me suis vu sur l’estrade d’une salle de conférences chaude et claire. Devant moi, était assis un auditoire attentif sur des fauteuils confortables. Je donnais un cours sur la psychologie des camps de concentration ! Tout ce qui m’oppressait à ce moment, devint une réalité objective vue et décrite par la science. Grâce à cette technique de pensée, j’ai réussi à m’élever au-dessus de la situation, des souffrances de cette journée et je les ai observées comme si elles étaient des souvenirs du passé.» trad.libre, p.82 (Frankl,1992). Si en rapportant la citation, Pepe (2011) rattache la description de ce processus cognitif à la résilience dont a fait preuve Frankl, nous ajouterions que cet exemple décrit bien l’élargissement de l’expérience de la pensée et la flexibilité psychologique, en ce que le témoin démontre qu’il observe ses propres processus internes et qu’il a conscience que le contenu de sa pensée anxieuse ne reflète pas toute la réalité. Le concept de flexibilité psychologique que nous utilisons ici vient de la théorie des cadres relationnels, qui postule que la rigidité ou l’inflexibilité psychologique est à la source de la majorité des problèmes psychologiques et qu’elle émerge des processus langagiers que l’humain utilise pour s’expliquer les événements contextuels [15]. En ce qui concerne l’intervention sur la santé psychologique au travail, la flexibilité psychologique se retrouve au centre du modèle d’acceptation et d’engagement (ACT) [16]. Dans le domaine de la résilience, une des toutes premières mentions de la flexibilité psychologique est retracée chez Block & Block [17], alors qu’on la retrouve mentionnée comme un facteur de protection personnel relié à la résilience des enseignants, chez des chercheurs contemporains [18] et qu’on y réfère comme un facteur de la santé [13].
1.3
Question de recherche
En nous situant au point de convergence d’une perspective positive de la santé psychologique et développementale de la résilience, notre question spécifique concerne les relations qui existent entre la flexibilité psychologique et la résilience au travail, en questionnant le rôle de l’acceptation des émotions et cognitions difficiles dans un contexte de gestion, qui valorise plutôt leur inhibition. Découlant du modèle théorique de la flexibilité psychologique, nous posons l’hypothèse que les directions qui acceptent leurs émotions et leur vécu difficiles seraient plus résilientes et éprouveraient davantage de bien-être au travail.
Méthodologie 1.1
Participants et questionnaires
À l’automne 2012, les directions d’établissement du primaire et du secondaire ont été invitées à participer à une étude sur leur santé psychologique au travail par une équipe de chercheurs canadiens. L’enquête visait à mieux cerner les facteurs organisationnels, psychosociaux et individuels qui affectent la santé psychologique et la performance au travail. L’invitation a été lancée via une plateforme internet dans deux provinces canadiennes dont nous rapportons ici une partie des résultats issus des directions d’écoles du Québec (N=232). Outre treize questions d’ordre sociodémographique, l’instrument de mesure est constitué de quatorze échelles et 232 items. Il couvre différentes dimensions du travail de direction d’une école et du bien-être au travail et leur est parvenu sous la forme d’un questionnaire électronique. Parmi les domaines de la santé investigués pour cette enquête, la flexibilité psychologique est mesurée par un questionnaire conçu par Hayes et ses collègues [19] dont la version courte a été validée [16] sous le titre “Anxiety Acceptance Questionnaire” (AAQ-II), que nous avons traduit en français. Il comporte sept items formulés négativement, dont «Mes inquiétudes peuvent m’empêcher de réussi », que le sujets sont appelés à rapprocher de leur expérience vécue, selon une échelle Likert en 7 points (1 = jamais vrai à 7 = toujours vrai). L’analyse factorielle révèle un seul facteur, qui explique 68% de la variance et un alpha de Cronbach de 0.92. La résilience est mesurée par l’échelle de résilience [20] .Elle comprend 23 items sur une échelle en 5 points (1 = presque jamais et 5 = presque toujours) dont «Lorsque survient une grande difficulté, j’ai tendance à : chercher une solution pour y faire face». L’alpha de Cronbach est de 0.86.
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Le bien-être psychologique (BEP) est mesuré par l’échelle de bien-être au travail [21]. Elle comprend 25 items sur une échelle en 5 points (1 =presque jamais et 5 =presque toujours) dont «J’ai un bon mora ». L’alpha de Cronbach est de 0.85. Tableau 1-Description des variables à l’étude
ÉCHELLE Flexibilité psychologique (AAQ-II, 7 items) Résilience (23 items) Bien-être psychologiqueau travail (25 items)
MOYENNE 2,14 3,95 3,79
ÉCART-TYPE 1,05 0,57 ,65
N 232 232 232
Résultats Les résultats divulgués ici sont partiels et leur présentation se concentre sur les liens entre la flexibilité psychologique et les dimensions positives de la santé au travail. Au plan descriptif des données sociodémographiques tout d’abord, les analyses de test T ne révèlent pas de différence significative sur la flexibilité psychologique entre les hommes et les femmes, lesquelles sont au demeurant majoritaires dans cet échantillon. Aucune différence significative n’est décelée sur cette variable et la scolarité, la charge de travail, ni sur la charge familiale. Par contre, on relève une différence significative entre les directions (M=1,98 ET= .08) et les directions adjointes (M= 2,34 ET= 1,16), indiquant moins de flexibilité chez ces dernières (vu l’inversion des énoncés, plus le score est bas, plus la flexibilité est grande), avec un petit effet de taille, selon les standards proposés par Cohen [22]. La distribution des scores de l’AAQ-II établit la moyenne de flexibilité psychologique à 2,14, révélant qu’elle est assez élevée pour cet échantillon de directions d’établissement. Les corrélations de Pearson montrent que la flexibilité psychologique et la résilience sont corrélées (R 2= 0.71 p ≤,001), de même que la flexibilité psychologique et le bien-être psychologique au travail (R 2= 0,52 p ≤,001). Après avoir constaté ces corrélations, des analyses de régression ont été conduites pour tenter de fournir une meilleure explication des liens et explorer le rôle de la flexibilité. Les analyses de régression simple montrent que la flexibilité psychologique, comme variable indépendante, explique une part des variances de plusieurs dimensions de la santé psychologique au travail: elle explique ainsi 24% de la variance du score de résilience F [1, 230]= 71,688, p < ,001) et 27% du score de BEP (F [1, 230]= 86.602, p < ,001). Elle explique encore 13% de l’adaptation au travail (F [1, 230]= 34.121, p < ,001),15% de l’harmonie au travail (F [1, 230]= 41.809, p < ,001), 19% de l’implication au travail (F [1, 230]= 55.443, p < ,001) et 29% de l’équilibre personnel au travail (F [1, 230]= 95,099 p < ,001). Par la suite, le rôle de médiation de la flexibilité psychologique a été estimé selon la procédure suggérée par Preacher & Hayes [23]. En explorant ces relations, on note que la FP exercerait un effet de médiation partielle entre la résilience et le BEP. Nous constatons aussi un effet de médiation de la FP dans la relation entre la justice organisationnelle et le BEP. La FP exerce encore un effet de médiation partielle dans la relation entre le climat organisationnel et le BEP, de même qu’entre les ressources organisationnelles et le BEP, et entre les demandes organisationnelles et le BEP.
Discussion Dans l’avancement de l’étude des processus de la résilience, ces résultats indiquent que la flexibilité psychologique, par l’acceptation des émotions difficiles, éclaire d’une façon différente la résilience et le bienêtre psychologique au travail, tout en permettant de concevoir des liens nouveaux que nous n’avions pas prévu au départ. Toutefois, la forte corrélation entre la résilience et la flexibilité psychologique impose une révision de la validité des deux construits, qui devrait permettre de vérifier qu’aucun recouvrement significatif n’explique cette relation. Sans doute importerait-il d’examiner l’instrumentation avant de pousser plus loin le questionnement sur des processus distincts. Mais, vu ses liens convergents et de bonne ampleur avec plusieurs dimensions positives, on peut supposer que la flexibilité psychologique pourrait bien être en soi, un facteur de protection personnel. La promotion de la flexibilité psychologique, particulièrement dans ce type de travail, aiderait les gestionnaires à maintenir ou accentuer les dimensions de leur santé, plutôt qu’à inhiber toute forme d’expression négative. Sans confirmer l’hypothèse d’une médiation de la résilience par la flexibilité, ces résultats montrent assez clairement que les directions d’établissement qui acceptent leurs émotions et leur vécu difficiles sont aussi résilientes et lorsqu’elles sont flexibles, elles éprouvent du bien-être au travail. Ces relations empiriques viennent enrichir les concepts à l’étude, mais ne permettent pas d’établir qu’un processus les relie l’un à l’autre. Tout au plus, pouvons-nous indiquer que la présence de flexibilité psychologique, en termes de mesure fiable [16] montre des liens théoriques avec la santé psychologique, mais sans pour autant confirmer la nécessité d’en tenir compte comme une voie qui mène à la résilience. Plusieurs processus pouvant être en jeu dans la résilience, cette
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conclusion n’invalide pas les interventions porteuses pour la santé psychologique, surtout lorsqu’elles révèlent des índices probants [12]. Bien qu’exploratoire, ce type d’analyse fine des processus de la résilience invite à accentuer les démarches d’explication des états positifs, en situation d’adversité [10]. De tels résultats permettent aussi de redéfinir la terminologie de la régulation des émotions négatives, souvent comprise en termes de diminution ou d’inhibition, en lui ajoutant l’acceptation, elle-même une notion encore peu connue. La capacité à observer pour ce qu’elles sont, ses émotions négatives comme une partie du vécu au travail pourrait permettre la récupération, l’équilibration, voire la promotion de solutions aux problèmes rencontrés, ce qui constitue la résilience. Surtout si la santé psychologique au travail des professionnels de l’éducation peut en être tributaire, on comprendra toute l’importance d’ajouter ce type de compétence émotionnelle à leur formation. On peut en effet supposer que l’amélioration des capacités fonctionnelles des gestionnaires est un critère important, lorsqu’il s’agit de dépasser les difficultés reliées au travail de gestion. Ayant déjà constaté que les facteurs de risque et de protection se ressemblent, tant au plan personnel qu’environnemental pour les enseignants et les directions d’écoles[24], il restera à vérifier si les enseignants peuvent aussi bénéficier des mêmes facteurs de protection personnels que les directions, particulièrement sur leur flexibilité psychologique et leur acceptation des émotions difficiles.
Conclusion Bien que comportant certaines limites méthodologiques, dont la passation par voie électronique qui rend impossible toute vérification de la qualité des réponses, cette recherche sur la santé psychologique au travail représente une certaine avancée sur le plan de l’explication des sources de la résilience. En considérant au rang des facteurs de protection, la flexibilité psychologique évaluée par l’acceptation des émotions difficiles, nos résultats apportent une validation supplémentaire du concept. En autant que l’on puisse mieux isoler son action au sein des processus, l’explication pourrait conduire à l’élaboration de stratégies d’intervention sur la résilience, et sur la résilience au travail.
Références [1] [2] [3] [4] [5] [6] [7]
[8] [9] [10] [11] [12] [13]
Masten, A. S., & O'Dougherty Wright, M. (2010). Resilience over the lifespan : Developmental perspectives on resistance, recovery and transformation. In J. W. Reich, A. J. Zautra, & J. Stuart Hall, Handbook of adult resilience (pp. 213-237). New York: Gilford. Ministère de l’éducation, des loisirs et du sport (2011). Poirel, E. & Yvon,F. (2011). Les sources de stress, les émotions vécues et les stratégies d’ajustement des directions d’école au Québec. Revue des sciences de l’éducation. 37 (3), pp.595-615. Garon, R., Théorêt,M. Hrimech,M.,Carpentier,A.(2006). Résilience et vulnérabilité chez des chefs d’établissement scolaire: une étude exploratoire. Psychologie du travail et des organisations.12, pp.327337. Pepe, J. (2011). The Relationship of Principal Resiliency to Job Satisfaction and Work Commitment: An Exploratory Study of K-12 Public School Principals in Florida. Ph.D. Dissertation: College of Education: University of South Florida. Sutton, R. Wheatley,K.F. 2003. Teachers’emotions and teaching: a review of the literature and directions for future research. Educational psychology Review. 15, pp.327-357. Curchod-Ruedi D. & Doudin, P.A. (2009).Leadership et émotions à l,école:fonction encadrante,compréhension et régulation des émotions dans le contexte scolaire. In Gendron, B. & Lafortune,L. Leadership et compétences émotionnelles dans l’accompagnement au changement.Montréal: P.U.Q. Abramowitz, J. S., Tolin, D. E., & Street, G. P. (2001). Paradoxical effects of thought suppression: A metaanalysis ofcontrolled studies. Clinical Psychology Review, 21, pp.683–703. Théorêt, M. (2005). La résilience : de l’observation du phénomène vers l’appropriation du concept en éducation. Revue des sciences de l'éducation, 31, (3) pp. 633-658 Davydov, D., Stewart, R., Ritchie, K. & Chaudieux, I.(2010) Resilience and mental health. Clinical Psychology Review, 30 (5) pp.479-495. Lee, J. H., Nam, S.K., Kim, B., Lee, M.Y., Lee, S.M.(2013). Resilience: A Meta-Analytic Approach. Journal of Counseling and Development. 91(3) pp.269-279. Monestes J.L. & Villatte, M.(2011). La thérapie d’acceptation et d,engagement. Paris: Masson. Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical psychology review, 39, pp. 865-878.
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[14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24]
Frankl, V. E. (1992). Man’s search for meaning. Boston: MA.Beacon Press. Hayes,S.C. Barnes-HolmesD., & Roche,B. (2001). Relational frame theory: A post-Skinnerian account of human language and cognition.N.Y.:Kluwer. Bond, F., Hayes, S., Baer, R.A., Carpenter, K. Zetlte, R. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy. 42(4), pp. 676-688. Block, J. (1995). A contrarian view of the five-factor approach to personality description. Psychological Bulletin, Vol 117(2), pp. 187-215. Beltman, S., Mansfield, C., & Price, A.(2011). Thriving not just surviving: A review of research on resilience. Educational Research Review, 6, 2011,pp. 185-207. Hayes, S., Luoma, J.B., Bond, F.W., Masuda, A., Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes.Behaviour Research and Therapy. Vol.44(1), pp.1-25. Brien, M., Brunet, L., Boudrias, J.-S., Savoie, A., & Desrumaux, P. Santé psychologique au travail et résilience : élaboration d'un instrument de mesure. In N. Petterson, J.S. Boudrias, & A. Savoie (Dir). Entre tradition et innovation, comment transformons-nous l'univers de travail ? Québec, Québec. Gilbert, M.-H. (2009). La santé psychologique au travail : conceptualisation, instrumentation et facteurs organisationnels de développement. Thèse doctorale inédite. Département de psychologie. Université de Montréal. Cohen, J. (1988).Statistical power for the behavioral sciences.N.Y.: Erlbaum associated press. Preacher, K.J.Hayes, A.F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instrumentation & Computers, 36(4),pp717-731. Théorêt, M., Garon, R., Hrimech, M., & Carpentier, A. (2006). Exploration de la résilience éducationnelle chez des enseignants. International Review of Education, 52, pp. 575-598.
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The Resilience-Oriented Therapeutic Model: A Preliminary Study On Its Effectiveness In Italian Polyabusers Bonfigli Natale S.1,2, Renati R.1,2, Farneti P.M.2 1 Department of Brain and Behavioural Sciences - University of Pavia (ITALY) 2 Archimede Research Center-Eris Foundation (ITALY)
[email protected] ,
[email protected] ,
[email protected]
Abstract The present article was intended to outline the guidelines of a new resilience-oriented therapeutic model of intervention and to present preliminary data about its effectiveness on a sample of polyabusers undergoing residential treatment. Resilience being a multidimensional process not easy to measure, in order to evaluate the effectiveness of our model we considered as indicators of resilience some of its outcomes that extant literature has described; in particular, we assessed, pre- and post-intervention, coping styles and perceived stress and psychological wellbeing, together with levels of anxiety and depression. Student’s t-test showed significant differences in all the scales, with the exceptions of the “humour” coping strategy and anxiety. The preliminary findings suggests that a targeted intervention shaped within the framework of a resilience-oriented model can facilitate the raising of resources that are useful to activate a resilient process. Keywords: Resilience, Intervention Model, Substance Abuse, Stress, Coping
Introduction Nowadays resilience must be considered as a major factor directing public health policy strategies aimed at promoting individual and collective functional responses to adversities. Recent advances in the study of resilience have considerably contributed to the knowledge of individual adjustment by focusing, among others, on the possibility to implement interventions aimed at activating a person’s resilient resources. Contemporary research on resilience is focused on the investigation of factors leading to wellbeing [1] and also seeks to highlight the underlying social and psychological processes and practices through which resilience may be achieved [2], [3], [4]. Intervention, in the field of substance use disorder, based on a resilience framework still represent a partially unexplored domain, since much of the extant literature on resilience has dealt with children’s and adolescents’ development within unfavourable contexts [5] or with responses to trauma and loss in adulthood [6]; furthermore, to date research on resilience and substance use disorder has been focused on the development of children with at least an addicted parent, or on community-based prevention actions, while researching on the implementation of intervention programs for adult with substance abuse problems is still a challenge. Resilience refers to a dynamic process by which an individual, a family, or a community system is able to adapt to and function well within a context characterized by significant adversity or risk [7], [8], [9]. Rather than as a trait, resilience should be construed as a set of processes that can be inferred when the individual or the system being considered shows competence in response to substantial risk exposure [8]. This ability can change over time and may be enhanced by protective factors related to the person and/or the environment [10]. The resilient process includes also the practices and strategies individuals resort to in order to mitigate the psychological distress related to the exposure to an adverse event. This evidence indicates that coping is a crucial construct for research on resilience that it is considered jointly a function of the stressful situation and the individual’s resources [11]. Various studies investigating stress-and-coping interaction models have been focused on the moderating role of certain strategies useful to face hostile situations and have shown how an addictive behavior, such as the use of alcohol and drugs, can be utilized to reduce or counter the effects of stress [12], [13]. It seems therefore that a central aspect of the resilient process can be identified in the quality of the regulatory competence that an individual displays when facing daily stressors. To respond in an adaptive way to unfavorable events or
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situations everyday life entails represents an essential prerequisite with reference to the ability to face major adverse events in a similarly adaptive way, by activating a resilient process [14].
The Resilience-Oriented Treatment Model The intervention model we designed [15] stems from resilience concepts, some key assumptions of Milton Erickson’s (1901-1980) intervention approach and from the evolutions of modern systemic theories on chaos [16], [17]. The intervention is articulated into four phases based upon three levels. The four phases are: 1) entrance, including a watching period during which an observation of the patient is carried out together with a first assessment consisting of the administration of tests specifically designed for measuring resilience and the associated constructs, and of an investigation into the patient’s life story with the collection of biographical information 2) treatment, carried out on three specific levels: vertical, horizontal and cross-domain 3) exit, with a re-assessment of resilience and finally 4) follow up, after 6 months and again after 1 year. The core of the resilience-oriented intervention develops through three levels, vertical, horizontal and cross-domain.
1.1
Vertical Level Of Intervention
The vertical intervention addresses each single patient and thus it must be “tailored” to the individual on the basis of her/his story, taking into account peculiar risk and protective factors. With the patients’ active participation a Resilient Therapeutic Program (from now on RTP) is planned: stress indicators related to the three areas – individual, familial and social – of resilience development are identified. For each indicator a prescription is given with reference to a concrete, feasible and measurable objective, on the basis of the person’s resilient characteristics (resources and protective factors) and of the analysis of the “attempted solutions”, that is, the dysfunctional modalities used in the past when trying to overcome a given stressful situation. Prescriptions, designed ad hoc for the patient and by the patient, stimulate the activation of a small-steps resilient process: trying their hand at facing minor, but significant daily stressful situations, individuals are given the chance to develop skills by activating coping strategies related to salient risk factors in their treatment and life trajectories [18], [19]. Cognitive and behavioral responses to these stimuli can activate one or more “turning points” [20], [21] helping the individual restructure her/his experiences through new learning. The RTP is constantly monitored and supervised by mentor figures (social workers, psychologists etc.) A roadmap is traced, that is a schedule by means of which patients actively commit themselves to organize their time (interviews with clinicians, participation in group activities, test completion etc.). The roadmap has the function to assign each patient the responsibility of her/his treatment course and, at the same time, to provide feedbacks stimulating self-regulation and self-reflexivity processes. Another example of vertical intervention is the assignment of a care-manager (that is, a figure in charge of tutoring and monitoring activities) to each patient, in accordance with the crucial relevance of the relationship with at least one reference figure in the activation of a resilient process extant literature on resilience has emphasized. Therefore, the care-manager represents the mentor with whom the patient, by means of interviews on a weekly basis, can discuss about the various aspects of the course of her/his treatment.
1.2
Orizontal Level Of Intervention
The horizontal intervention refers to experiential moments involving patients in group activities, and is structured in a way that allows to work on the risk and protective factors characterizing the problematic situation shared by all group members, for example: addiction (tailoring on the category of users). The intervention is carried out within specific settings designed to facilitate and foster the activation of implicit associative processes between the risky situation (stressor) and specific protective factors related to the specialist activity being performed, in order to generate functional coping and regulation strategies. This kind of intervention helps participants to use social resources like the group and/or the activity conductor (with tutoring or mentoring functions), in addition to the resources the activity itself provides. At the horizontal level, both a direct form of learning (achieved by doing) and an indirect one (through the observation of the other group members) are stimulated.
1.3
Cross Domain Level Of Intervention
The cross-domain intervention pertains to the context within which the model is applied. The physical and relational space the therapeutic program develops within must be structured and managed in a way that
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allows it to become a “container” of resources. According to this perspective, the intervention is structured in order to provide a continuous and constant monitoring and supervision of the work carried out by educators, social workers and specialists. Emphasis is put on the communication, support, coordination and reflection systems. The staff, activities, rules, values, team meetings, activity planning, physical environment, represent crucial context-related protective factors. At this level the intervention targets the organizational system and consequently the workers who represent one of the key components of the work setting. Indeed, some actions (implemented both at the vertical and the horizontal level) are tailored to the workers’ characteristics. In particular, actions of supervision and training specifically related to the theme of resilience. Furthermore, similarly to what has been established for patients who are required to complete the RTP, instruments were created for the assessment of the workers’ and the whole structure resilient processes: the RWP (Resilient Work Program) and the RSP (Resilient Structure Program); their aim is to help workers identify individual, group, organizational and structural resources and protective factors, useful to cope with difficulties and work-related stressful conditions. The groundbreaking and, in our view, particularly relevant element is the introduction of the Online Diary, an electronic tool accessible through an Internet connection, organized as an online forum. By this diary each worker can be updated in real time about the organizational decisions, the course of the collective activities, the patients’ conditions. The diary also makes it possible to examine patients’ tests and intervention programs and to check the course of each single activity every patient participates in. In general, the diary is associated to the acronym SIL, representing its three basic functions: Sharing, Informing, Learning. The cross-domain level is, in our view, perhaps even more important than the other two; it does not involve directly the individuals undergoing the treatment, but it is based upon the idea that patients need to be supported by a resilient context and it is designed to allow the structuring of such a context. In a systemic perspective, resilience is a phenomenon strongly mediated by environmental factors, and consequently it is essential to build a resilient community context: the activation of a resilient process can be very difficult, if not impossible, if the context does not provide or facilitate the access to resilient resources.
Method 1.1
Hypotheses
We postulated that our resilience-oriented intervention model could be effective in triggering resilience in polyabusers. Resilience being a process, its assessment is not easy, unless we consider as indicators the outcomes of the process itself in terms of coping skills and stress perception. Thus, to demonstrate the effectiveness of our model, we hypothesized that the treatment would a) have positive effects on participants’ perception of their psychological condition, b) decrease their levels of perceived stress and c) elicit an improvement of the use of adaptive coping strategies.
1.2
Participants
Our sample includes 57 subjects (M=37; F=20), mean age 42.3 years (SD = 9.8), undergoing a residential treatment program in two therapeutic rehabilitation centers for polyabusers located in the Lombardy region (Italy). Both centers apply a resilience-oriented therapeutic intervention model and host individuals diagnosed with alcohol or substance abuse associated to poly-abuse of other psychotropic substances. The two centers differ in that one carries out a rehabilitation program that lasts two and a half months (P1), while the other’s program (P2) takes 6 months to be carried out. Among the 57 subjects involved in our research, 37 participated in P1, the other 19 in P2.
1.3
Measures
Coping Strategies. The Italian validated version of the Coping Orientation to Problems Experiences (COPE – [30], [31], consisting of 60 items subdivided into 15 subscales. Respondents are asked to indicate to what extent they adopt the investigated coping strategies while experiencing stressful or difficult situations. Items are rated on a 4-point scale: I usually don’t do this at all; I usually do this a little bit; I usually do this a medium amount; I usually do this a lot. The 15 subscales are: 1) active coping; 2) planning; 3) suppression of competing activities; 4) restraint coping; 5) seeking support for instrumental reasons; 6) seeking support for emotional reasons; 7) emotional venting; 8) positive reinterpretation and growth; 9) acceptance; 10) religion; 11) humour; 12) denial; 13) behavioral disengagement; 14) mental disengagement; 15) alcohol and substance use. Psychological Condition: Cognitive Behavioural Assessment - Outcomes Evaluation (CBA-VE – [24], consisting of 80 items assessing the patients’ psychological condition during the last 15 days. Answers are rated
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on a 5-point scale: No at all / A little /A medium amount / A lot / Extremely. The test comprises five scales: 1) anxiety; 2) wellness; 3) perceived positive changing (i.e., being able to manage difficulties and to receive support from others); 4) depression; 5) psychological discomfort (i.e., the presence of serious symptoms and low impulse control). Psychosomatic response to stress: the PHIT Subscale is part of the Italian validation of the Occupational Stress Inventory (OSI – [25]. It consists of 12 items rated on a 6-point scale: very often / often / sometimes / seldom / very seldom / never.
1.4
Procedure
Participants were recruited in two therapeutic rehabilitation centers for polyabusers located in the north of Italy. All the subjects were not intoxicates or in need of medical assistance at the time of the test administration. The instruments described above were counterbalanced in an attempt to offset possible ordering effects and were administered to participants individually, during scheduled appointments in two different times: one week after the beginning of the residential treatment and one week before the release of the residential treatment. The pre and post-test screening battery were administered to participants by computer, under the supervision of a researcher, and it takes forty-five minutes to complete. Instructions on how to respond to items in each instrument were provided by professional clinical psychologist. Informed consent was obtained from all participants. This study was approved by the appropriate ethics review board prior to initiation.
1.5
Data analyses and results
To evaluate the effectiveness of the treatment a One-Sample Student t test was performed to compare scores at the beginning and at the end of treatment in the COPE, CBA-VE scales, and with reference to the dimension of psychosomatic stress as it can be measured by the subscale PHIT. Please note that the following findings refer to the global sample, because no statistically significant differences emerged between the two subsamples (participants in the P1 and P2 programs) and between gender. Following the authors’ scoring instructions, scores were calculated with reference to each subscale, by summing its items. Missing data were replaced by the means of the series. All scales had positively-oriented scores: high scores showed the presence of the measured dimension, while low ones indicated its absence. Significant pre- and post-treatment differences were found with reference to all the analyzed scales, with the exception of the humour, focus on and venting of emotions and turning to religion ones. The table below (Fig. 1) shows the means referring to each scale.
COPE mental disengagement focus on and venting of emotion seeking social support instrumental reasons active coping
for
Denial Humour turning to religion behavioural disengagement restraint coping seeking social support for emotional reasons alcohol-drug disengagement acceptance suppression of competing activities planning positive reinterpretation and growth
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Post-treatment mean
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.057
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.7
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7 7.3 7.4 7.2 8.7
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CBA-VE anxiety wellness perception of positive changing depression psychological discomfort PHIT psychosomatic stress
15.8 42.4 24.9 17.4
12.6 48.3 26.9 13.8
4.1
56
.001
-3.5
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56
.011
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56
.001 .001 .001
44.4
35.7
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Figure 1. Shows the means referring to each scale, reporting pre- and post-treatment means, t values, degrees of freedom and significance.
With reference to the adopted coping strategies, results showed an improvement, with an increase of scores between the beginning and the end of treatment, an increase that was statistically significant in relation to adaptive strategies as seeking social support for instrumental reasons, active coping, restraint coping, seeking social support for emotional reasons, acceptance, suppression of competing activities, planning, positive reinterpretation and growth. Pre- and post- treatment difference in the humour and turning to religion strategies was not significant; pre- and post- treatment difference in the focus on and venting of emotions strategy was near significant. As for maladaptive strategies like denial, behavioral disengagement, mental disengagement and alcohol-drug disengagement, post-treatment scores were significantly lower, thus indicating the participants’ tendency to use these strategies less. Results in the CBA – VE scales (referring to the subjects’ perception of their psychological condition) showed a positive trend in the measures of wellness and perception of positive changing; as for scores in the depression and psychological discomfort and anxiety scales, significant decreases between the beginning and the end of treatment were shown. Finally, levels of psychosomatic stress, measured with the subscale PHIT, were found to have significantly decreased at the end of treatment.
Discussion The aim of the present work was the preliminary assessment of the effectiveness of a new resilienceoriented intervention model on a sample of polyabusers undergoing residential treatment. Extant literature on the possible measures to take in order to activate a resilient process present inconsistent evidence. Resilience is construed as an abstract concept and a process whose indicators can be assessed only through the evaluation of its outcomes, in terms of adaptive coping strategies that are useful to manage stressors. Therefore, on the basis of the landmark studies on the issue [26], [27], [28], [7], we chose to take into consideration hypotheses related to the decrease of stress levels, the increase of perceived well-being, and to the adoption of functional strategies for coping with stressful conditions and difficulties, in order to evaluate the treatment we proposed. The findings we presented allow us to consider the resilience-oriented model, whose guidelines were described in detail, as a valid instrument for the residential treatment of patients with alcohol and substance abuse problems. In fact, our hypotheses were confirmed, thus giving positive indications on the model effectiveness, at least in relation to the investigated aspects. Despite its encouraging preliminary findings, this work has some limitations that are worth noting. First, it does not demonstrate that a subject can become resilient, but it only suggests that a targeted intervention shaped within the framework of a resilience-oriented model can facilitate the raising of resources that are useful to activate a resilient process. Furthermore, the small sample cannot give guarantees about the model effectiveness, and the lack of a follow-up assessment makes it impossible, to date, to provide any evidence of the stability of the triggered changes over time.
References [1]
Fredrickson, B.L., Joiner, T. (2002). Positive Emotions Trigger Upward Spirals Toward Emotional WellBeing. Psychological Science, 13, 172–175.
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[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24]
[25] [26] [27] [28]
Davydov, D.M., Stewart, R., Ritchie, K., Chaudieu, I. (2010). Resilience And Mental Health. Clinical Psychology Review, 15-37. Masten, A.S., Long, J.D., Kuo, S.I.-C., Mccormick, C.M., Desjardins, C.D. (2009). Developmental Models Of Strategic Intervention. European Journal Of Developmental Science, 3, 282-291. Ong, A.D., Bergeman, C.S., Bisconti, T.L., Wallace, K.A. (2006). Psychological Resilience, Positive Emotions, And Successful Adaptation To Stress In Later Life. Journal Of Personality And Social Psychology, 91, 730–749. Fergus S., Zimmerman, M.A. (2005). Adolescent Resilience: A Framework For Understanding Healthy Development In The Face Of Risk. Annual Review Of Public Health, 26, 399–419. Bonanno, G.A. (2004). Loss, Trauma, And Human Resilience: Have We Underestimated The Human Capacity To Thrive After Extremely Aversive Events? American Psychologist, 59(1), 20-28. Luthar, S.S., Cicchetti, D., Becker, B. (2000). The Construct Of Resilience: A Critical Evaluation And Guidelines For Future Work. Child Development, 71(3), 543–562. Masten, A.S., Coatsworth, J.D. (1998). The Development Of Competence In Favorable And Unfavorable Environments: Lessons From Research On Successful Children. American Psychologist, 53, 205–220. Ungar, M. (2011). Community Resilience For Youth And Families: Facilitative Physical And Social Capital In Contexts Of Adversity. Children And Youth Services Review, 33(9), 1742-1748. Masten, A.S. (2004). Regulatory Processes, Risk, And Resilience In Adolescent Development. In R.E. Dahl, L.P. Spear (Ed). Adolescent Brain Development: Vulnerabilities And Opportunities. New York Academy Of Sciences: New York. Frydenberg, E. (2004). A Universal Approach To Coping Skills Development And Its Application For Career Teachers. GIPO Giornale Italiano Di Psicologia Dell'Orientamento, 5(2), 3-13. Wagner, E.F., Myers, M.G., Mcininch, J.L. (1999). Stress-Coping And Temptation-Coping As Predictors Of Adolescent Substance Use. Addictive Behaviors, 24(6), 769-779. Jacobs, D.F. (1986). A General Theory Of Addictions: A New Theoretical Model. Journal Of Gambling Behavior, 2(1), 15-31. Dicorcia, J.A, Tronick, E. (2011). Quotidian Resilience: Exploring Mechanisms That Drive Resilience From A Perspective Of Everyday Stress And Coping. Neuroscience And Biobehavioral Reviews, 35(7), 1593-1602. Bonfiglio, N.S., Renati, R., Farneti, P.M. (2012). La Resilienza Fra Rischio E Opportunità. Alpes, Roma. Chamberlain, L.L., Butz, M.R. (1998). Clinical Chaos: A Therapist’s Guide To Nonlinear Dynamics And Therapeutic Change. Brunner/Mazel: New York. Butz, M.R. (1997). Chaos And Complexity: Implications For Psychological Theory And Practice. Taylor Francis: Philadelphia. Luthar, S.S., Zelazo, L.B. (2003). Research On Resilience: An Integrative Review. In S.S. Luthar (Ed). Resilience And Vulnerability: Adaptation In The Context Of Childhood Adversities. Cambridge University Press: New York. Yates, T.M., Egeland, B., Sroufe, L.A. (2003). Rethinking Resilience: A Developmental Process Perspective. In S.S. Luthar (Ed). Resilience And Vulnerabilities: Adaptation In The Context Of Childhood Adversities. Cambridge University Pres: New York. Flach, F. (1988). Resilience: Discovering A New Strength At Times Of Stress. Ballantine Books: New York. Horowitz, F.D. (1987). Exploring Developmental Theory: Toward A Structural/Behavioral Model Of Development. Lawrence Erlbaum Associates: Hilldsale. Carver, C.S., Scheier, M.F., Weintraub, J.K. (1989). Assessing Coping Strategies: A Theoretically Based Approach. Journal Of Personality And Social Psychology, 56(2), 267-283. Sica, C., Novara, C., Dorz, S., Sanavio, E. (1997). Coping Orientation To Problem (COPE): Traduzione E Adattamento Italiano. Bollettino Di Psicologia Applicata, 223, 25-34. Michielin, P., Vidotto, G., Altoè, G., Colombari, M., Sartori, L., Bertolotti, G., Sanavio, E., Zotti, A.M. (2008). Proposta Di Un Nuovo Strumento Per La Verifica Dell’efficacia Nella Pratica Dei Trattamenti Psicologici E Psicoterapeutici. Giornale Italiano Di Medicina Del Lavoro Ed Ergonomia, 30, 1, A98A104. Sirigatti, S., Stefanile, C. (2002). OSI – Occupational Stress Indicator. Giunti OS, Organizzazioni Speciali, Firenze. Henley, R. (2010). Resilience enhancing psychosocial programmes for youth in different cultural contexts: Evaluation and research. Progress in Development Studies, 10(4), 295-307. Masten, A.S., Obradović, J. (2006). Competence And Resilience In Development. Annals New York Accademy Of Science, 1094, 13-27 Meschke, L.L, Patterson J.M. (2003). Resilience As A Theoretical Basis For Substance Abuse Prevention. The Journal Of Primary Prevention, 23, (4), 483-514.
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Resilience in Oncology Patients: The role of coping mechanisms Bredicean C.1, Papava I.1, Pirvulescu A.2, Giurgi-Oncu C.1, Ile L.3,4, Popescu A.3, Hurmuz M.3 1
“Victor Babeş“ University of Medicine and Pharmacy Timișoara, “Eduard Pamfil” Psychiatric Clinic Timișoara, (ROMANIA) 2 Oncology Clinic Timisoara, oncologist (ROMANIA) 3 “Eduard Pamfil” Psychiatric Clinic Timișoara (ROMANIA) 4 „ Mara” Mental Health Center Timisoara (ROMANIA)
[email protected],
[email protected],
[email protected],
[email protected],
[email protected],
[email protected],
[email protected]
Abstract Introduction. Cases of cancer have increased greatly over the last decades. Over the same period, medical progress in the field of oncology (including developments in surgical interventions, chemotherapy and radiotherapy) has led to an increase in the survival rates of people diagnosed with cancer. In light of this, there is growing interest in the concept of resilience and understanding which factors enable individuals to enjoy a good quality of life in spite of a diagnosis of cancer. Objectives. To identify the coping mechanisms of individuals diagnosed with cancer compared with non-clinical subjects. Method. Nineteen individuals diagnosed with cancer who were receiving chemotherapy were recruited to the study. For comparison, a control group of non-clinical participants were also recruited. Participants were included into the study according to particular inclusion / exclusion criteria. The evaluation was conducted during 2013 and consisted of the analysis of the following parameters: socio-demographic data (gender, age, level of education- demographic questionnaire), clinical data (diagnosis according to the ICD 10, level of functioning as assessed by GAF scale), and coping mechanisms (COPE scale). Results. The group of individuals diagnosed with cancer demonstrated coping mechanisms that were characterised by an emphasis on social support (religiosity, social and emotional support), whereas the control group had coping mechanisms that focused on emotions. Conclusions. There are differences in coping mechanisms between subjects with cancer compared to the non-clinical group. It may be that coping mechanisms can be optimized through psychotherapy interventions to increase resilience of individuals diagnosed with cancer. Keywords. resilience, coping mechanisms, oncological pathology
Introduction Oncological pathology falls into the chronic diseases category affecting the overall functioning and quality of life of patients, both through the clinical symptoms and by the therapeutic scheme to be followed. The presence of oncological illnesses causes a change in a person's life by bringing on an intense state of anxiety induced by the negative situation, but also the need for adjustment. Adaptation is reached through the process of coping, which can be defined as the cognitive and behavioral effort to reduce, control or tolerate the internal or external demands that are required to overcome the situation [1]. The available literature [2] describes several ways of coping: • The process of coping centered on the issue that includes an active approach, planning, suppression of competing activities • The coping mechanism centered on emotions that includes: positive interpretation, abstention, acceptance, the religious approach • The coping centered on social support: the use of instrumental social support, the use of emotional social support, expressing the emotions • The coping focused on avoiding problems: denial, mental disengagement, behavioral disengagement
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As is the case in general medicine, the scope of oncology is to ensure that a person who has a diagnosis of cancer should be able to still develop well, to continue, as much as possible, with their future projects, and to ensure that they have an ability of resilience. Coping mechanisms are part of resilience, along with other factors, such as high intellectual endowment, the capacity for autonomy and adaptation, empathy, appropriate humor etc. The purpose of this study was to identify the coping mechanisms of some subjects with an oncological pathology compared with those of subjects without a pathology.
Method In this study we comparatively analyzed two groups: group A (n = 19) consisting of subjects with an oncological pathology and a group B (n = 19) with persons without a cancer pathology. Subjects in group A were introduced in the study on the basis of inclusion / exclusion criteria that included: a clinical diagnostic of cancer (according to the ICD 10), currently treated with chemotherapy, the absence of an organic cerebral pathology, and the subjects' consent for participation in the study. Group B was a control group formed in accordance to the demographics of group A. Data were obtained through: direct interviews with the subjects, medical records and discussions with the attending oncologist for each of the cases. We analyzed the following parameters:
Socio-demographic: current age, gender, origin, instructional level, family status Clinical: oncology clinical diagnosis, duration of evolution of the pathology, family history of cancer Coping mechanisms: COPE scale - which is a self-assessment tool that comprises of 60 items. This scale examines the 15 coping strategies, with each strategy being assessed by 4 items. The answer for each item is made on a Likert scale from 1 to 4, with 1 meaning ‘I do not do this’ and 4 meaning ‘I often do this’ [2].
Results Socio-demographic data are presented in table 1. Table 1 Socio-demographic data group A
Sample A , N = 19 subjects Gender Men Women Current average age (years) Origin Urban Rural Average time of education (years) Current family status Married Unmarried Widowers
68,4 % 31,6 % 60,89 42,1 % 57,9 % 10,94 84,2 % 5,2 % 10,6 %
Evaluation of cancer history showed that this was present in 37% of subjects, and the average duration of evolution was 4.42 years (maximum 16 years - minimum 1 year). The clinical diagnosis of the subjects in group A is shown in Fig 1.
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6 5 4 3
number of subjects
2 1 0 digestive
lung
bladder
cutaneous
Fig.1 Clinical diagnosis group A
The COPE questionnaire results were analyzed in comparison with those of a group of subjects without a cancer pathology, and are shown in Fig 2.
Fig.2 COPE questionnaire sample A/ sample B
Discussions The socio-demographic data in this study have no epidemiological value, because of the reduced number of subjects, as well as their inclusion having been done without a statistical methodology. The group was comprised of several types of subjects, i.e. with different oncological pathologies, with different staging, with different duration of evolution and treatments. We might say that the group is quite varied. The COPE questionnaire assesses 15 categories of coping: positive interpretation and growth, mental disengagement, focus on expressing emotions, the use of instrumental social support, active approach, denial, religious approach, humor, behavioral disengagement, abstinence, use of emotional social support, substance use, acceptance, suppression of competing activities and planning. The comparative analysis of these mechanisms showed no statistically significant differences in any of these areas, except for the religious coping, meaning that this mechanism is more developed in individuals with a cancer pathology. By analyzing religious coping we can say that it consists of two components: the cognitive one (the subject perceives the neoplastic disease as part of God's plan) and the behavioral component (the subject is praying or attending religious services). In literature there are several studies on subjects with oncological pathologies, with most being performed on patients with the same type of cancer. The most frequently analyzed
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pathologies are: breast, head, throat, skin, and gastrointestinal. Fewer studies are composed of patients with various types of neoplastic pathology. In general, research focuses on the relationship between religious coping and maintaining a state of well-being, of increasing the quality of life and possibly enhancing the survival period. Religious coping may be associated with disease stage, the type of treatment received, usually being more developed in cases with high malignancy or those who have to undergo more complex surgical interventions [3][4]. This study only managed to perform a cross analysis of coping mechanisms and their comparison with those of a group of subjects without a pathology. We would have expected to find other coping mechanisms to be developed in people with an oncological pathology, such as: active approach, the use of instrumental social support, and acceptance, besides the religious coping mechanism. The role of this type of coping can be varied, i.e. it can give meaning to a negative event, it can provide a sense of control in a difficult situation, it can offer a support group conducted by people who do not suffer from this serious health problem. Through all of this, in reality, religious coping has a positive role in the life of a person suffering with cancer, but it might also have a negative role, when considering the refusal of treatment, with the patient is certain of the idea that God would solve them all. Another possible explanation for the development of religious coping is the age of the subjects that can be seen as more advanced (average age - 60.8 years) and, therefore, it generally appears as a return to the religious aspect of life, with the perspective of death also occuring in a greater percentage for some of these subjects.
Conclusions Subjects with an oncological pathology have a more developed religious coping than those without. It may be that coping mechanisms can be optimized through psychotherapy interventions to increase resilience of individuals diagnosed with cancer.
References [1] [2] [3] [4]
Folkman, S., Lazarus, R.S.(1985). If it changes, it must be a process; study of emotion and coping, during three stages of college examination. Journal of Personality and Social Psychology, 48, 150-170 Carver, C. S., Scheier, M. F. & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56, 267-283 Thune-Boyle, I.C., Stygall, J.A., Keshtgar, M.R., Newman, S.P.(2006). Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Social Science & Medicine, 63, 151–164 Gall, T. L., Miguez de Renart, R. M., & Boonstra, B.(2000). Religious resources in long-term adjustment to breast cancer. Journal of Psychosocial Oncology, 18, 21–37
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Resilience, coping strategies and metabolic control in adolescents with type 1 diabetes Cosma A.¹, Băban A.² ¹Department of Psychology Babeş-Bolyai University, Cluj-Napoca (Romania) ²Department of Psychology Babeş-Bolyai University, Cluj-Napoca (Romania)
[email protected],
[email protected]
Abstract Many adolescents with type 1 diabetes have difficult time adjusting to their treatment. Increasingly, researchers have focused on the factors that influence resilience in coping to this chronic disease. Social cognitive theory suggests that dealing with a chronic disease requires a strong sense of self efficacy in the face of personal, social and, environmental barriers. We aim to document the association between coping strategies and metabolic control in relation to eating pattern among adolescents with type 1 diabetes as indicator of resilience. More specifically, we focus on the association between self efficacy and compensatory behavior, as coping strategies, and their effects on metabolic control. Based on the results, suggestions for designing intervention to increase metabolic control and resilience in coping with the challenges of the disease for adolescents with type 1 diabetes will be made. Key words: diabetes, adolescents, resilience, coping style
Introduction One well-known fact about living with diabetes is the requirement to establish optimal blood glucose levels and to maintain the individual’s quality of life for as long as possible. This requirement proves difficult to keep, especially during adolescence. Many adolescents with type 1 diabetes (T1D) have difficult time adjusting to their treatment, which can have a negative impact on their health [1]. Investigating the literature, resilience is related to metabolic control and it is defined in terms of resources that may be protective to those facing the stressors associated with living with diabetes [2]. Although there is a large amount of data investigating the relationship between coping styles and diabetic outcomes [3], there are few studies that explore the relationship between resilience, coping styles and metabolic control. Lately, researchers have focused on understanding how maladaptive coping styles, as compensatory behavior and low self efficacy, relate to eating pattern in order to shed a light on poor metabolic control in adolescents with T1D [4]. We aim to document in the literature the association between coping strategies and metabolic control in relation to eating pattern among adolescents with type 1 diabetes as indicator of resilience. More specifically, we focus on the association between self efficacy and compensatory behavior, as coping strategies, and their effects on metabolic control.
The relationship between resilience, coping styles and metabolic control Resilience is a psychosocial construct referring to an individual’s capacity to maintain psychological and physical well-being in the face of adversity [2]. Although this concept has been investigated in children and adolescents [5], little is known about resilience in children and adolescents living with diabetes. One explanation for this lack of research is that there is no universal agreement on what constitutes resilience. On the other hand, in the literature, there is not a clear distinction between predictor and outcome in terms of resilience [6]. Reviewing the literature, resilience resources appear to predict metabolic control and also to buffer self care behaviors. Those with lower levels of resilience resulted in fewer self-care behaviors when faced with rising distress [7]. Another study shows that low resilience is associated with poor quality of life and poor glycemic control [7]. Specifically, those with low resilience showed deteriorating A1C levels and self-care behaviors in
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the face of stress, while those with high resilience did not. The follow up study showed that maladaptive coping is an important mechanism of this association [8]. Understanding the role and impact of personal resilience may be an important way to improve outcomes among youth with T1D. Specifically, the literature suggests that promoting resilience helps improve coping which thereby may enable better health outcomes [7]. Therefore, understanding the coping styles used by adolescents with T1D can shed a light on ways to improve metabolic control. On one hand, there is a large amount of studies investigating coping styles in adolescents with T1D and on the other hand, there are few studies that show the relationship between resilience and coping styles. There are two approaches used in the literature: problem or emotion focused coping [9] and primary, secondary and disengagement coping [3] . Coping styles refer to strategies that people use to cope across wide range of stressors [9]. It has been suggested that problem-focused coping is associated with better adjustment to diabetes [6]. On the other hand, avoidance coping and venting emotions have been found to predict poor illness-specific self-care behavior but were unrelated to metabolic control [10]. These evidence are also supported in a study [11] showing that greater use of active coping was related to better metabolic control. Authors highlight the fact that adolescents might “choose” a particular coping style in response to poorly controlled diabetes, meaning that beliefs about control play an important role in determining the degree to which a person feels threatened or challenged in stressful encounter [9]. Mental disengagement and aggressive coping might thus serve as adaptive mechanisms. Another approach used in the literature shows that is important to consider developmental stage when assessing coping strategies in adolescents [3]. In recent lights, emotion and problem focused coping are considered broad categories of coping, neither exclusive nor exhaustive [12]. For example, a coping strategy such as forming a plan may help to solve a problem and also help to relieve negative emotions. Revisiting this evidence, there is a clear shift into a new model of assessing coping strategies in adolescent with T1D. Authors of this new conceptualization recognize the role of development proposing three coping strategies [3] . Primary control engagement coping strategies are defined as coping attempts directed towards influencing objective events/ conditions or directly regulating one’s emotions. Secondary control engagement coping strategies are defined as efforts to fit with or adapt to the environment. Disengagement coping strategies are defined as responses that are oriented away from the stressor or one’s responses to it [13] . One study investigated coping in relation to resilience in adolescents with T1D using a developmentally sensitive measure of coping [2]. The results indicated that adolescents that were more likely to use secondary control coping strategies, such as acceptance and distraction, had higher quality of life and metabolic control. Regarding the use of primary control coping strategies, such as problem solving and emotional expression, it was associated with positive outcomes of resilience, including metabolic control. Disengagement coping strategies, such as avoidance and denial, were associated with lower levels of resilience and poorer metabolic control [2]. Another line of research shows the relationship between coping strategies, compensatory behavior and metabolic control. Specifically, the most investigated relationships are between treatment related factors and poor metabolic control and, to a lesser extent, on psychosocial factors underlying maladaptive coping styles. The risk of disordered eating behavior is considered to be higher in type 1 diabetic adolescents than in general population due to combined factors related to diabetes and its treatment [14]. Because the diabetes regime often requires the restriction of food, adolescents are more prone to activate compensatory behaviors, in terms of splitting insulin doses, insulin omission, restricting food intake in order to reduce weight. These are considered maladaptive coping styles which have a negative effect on metabolic control. Poorer adherence to diabetes care is related to self efficacy- the degree to which adolescents with T1D feel confidence in their ability to follow their diabetic regime [15]. Among youth with diabetes, lower self efficacy was related to poorer metabolic control [4].
Conclusions The purpose of this paper was to document the relationship between resilience, coping styles and metabolic control in adolescents with T1D. Revisting the literature, we aimed to integrate both classical and recent studies attempting to highlight different coping styles in relation with metabolic control. Two general types of approaches have been analyzed: problem-focused and emotion-focused coping [9] and primary engagement, secondary engagement, and/or disengagement coping strategies [3]. Studies suggest that primary and secondary control coping strategies are associated with better metabolic control [2]. Lately, researchers have focused on understanding how maladaptive coping styles, as compensatory behavior and low self efficacy, relate to eating pattern in order to shed a light on poor metabolic control in adolescents with T1D. Health promotion interventions should be designed to help adolescents to better integrate the challenges of the illness into routine outpatient care. Management of maladaptive coping styles should address cognitive behavioral modification, social problem solving, coping skills training. Adopting more constructive self care
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behavior and coping mechanisms will form healthy life routines in order to optimize metabolic control and quality of life.
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]
Hoey, H., Mortensen, H., McGee, H., & Fitzgerald, M., for the Hvidore Study Group (1999). Is metabolic control related to quality of life? A study of 2103 children and adolescents with IDDM from 17 countries. Diabetes Research and Clinical Practice, 44(Suppl), S3. Jaser, S.S. and White, L.E. (2011) Coping and resilience in adolescents with type 1 diabetes. Child Care Health Development 37(3), pp. 335–342. Compas, B.E., Connor-Smith, J.K., Saltzman, H., Thomsen, A.H., Wadsworth, M.E. (2001) Coping with stress during childhood and adolescence: progress, problems, and potential in theory and research. Psychological Bulletin; 127, pp. 87–127. Young-Hyman, D.L. and Davis, C.L (2009) Disordered Eating Behavior in Individuals With Diabetes. Diabetes Care, Vol. 33( 3). Masten, A.S. (2007) Resilience in developing systems: progress and promise as the fourth wave rises. Development and Psychopathology 19, pp. 921–930. Kliewer, W. (1997) Children’s coping with chronic illness. In Handbook of Children’s Coping: Linking Theory and Intervention. Wolchik SA, Sandler IN, Eds. New York, Plenum, pp. 275–300. Yi, J.P., Vitaliano, P.P., Smith, R.E., et al. (2008) The role of resilience on psychological adjustment and physical health in patients with diabetes. British Journal of Health Psychology 13, pp. 311–325. Yi-Frazier, J.P., Hilliard, M., Cochrane, C., et al. (2013) The impact of positive psychology on diabetes outcomes: A review. Psychology 3, pp. 1116–1124. Lazarus, R.S. and Folkman, S. (1984) Stress, Appraisal, and Coping. Springer; New York, NY, USA. Hanson, C.L., Cigrang, J.A., Harris, M.A., Carle, D.L., Relyea, G., Burghen, G.A. (1989) Coping styles in youths with insulin-dependent diabetes. Journal of Consult Clinical Psychology 57, pp. 644–651. Graue, M., Wentzel-Larsen, T., Bru, E., Hanestad, B.R., Sovik, O. (2004) The coping styles of adolescents with type 1 diabetes are associated with degree of metabolic control. Diabetes Care 27, pp. 1313–1317. Skinner, E.A., Edge, K., Altman, J., Sherwood, H. (2003) Searching for the structure of coping: a review and critique of the category systems for classifying ways of coping. Psychological Bulletin 129, pp. 216– 269. Connor-Smith, J.K., Compas, B.E., Wadsworth, M.E., Thomsen, A.H., Saltzman, H. (2000) Responses to stress in adolescence: measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology 68, pp. 976–992. Colton, P., Rodin, G.M., Olmsted, M.P., Daneman, D. (1999) Eating disturbances in young women with type 1 diabetes mellitus: mechanisms and consequences. Psychiatric Annual 29, pp. 213–218. Bandura, A. (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychological Review 84, pp. 191-215.
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Resilience and coping in sexually abused teenage girls Dubuc L. Université du Québec à Trois-Rivières (Canada)
[email protected]
Abstract Scientific research on sexual abuse in childhood has experienced long-term growth show great variation. The fact that as high as half proportion of sexually abused children show no symptoms turned out one of the most stable [1] data. Adaptation or coping strategies [2] and resilience (complex process of adapting flexibly to trauma or stress [3] ) have been proposed as factors that may explain the variability or absence of symptoms in some victims sexual abuse. The objective of this research is to attempt to clarify the variables that promote good adaptation of adolescent victims of sexual assault. Participants (19 sexually abused adolescent aged 13-18 years) were recruited through announcements. The instruments used were: the French translation of the Brief COPE [4] and the Questionnaire Resilience by Wagnild & Young [5]. The evaluation of symptoms of post-traumatic stress disorder was made using the criteria of PTSD [6]. We will present the results to both questionnaires based on the determined diagnosis for each participant. Key-words: resilience, sexual abuse, adolescent
Instruments 1.1
Defense Style Questionnaire (DSQ).
Les mécanismes de défense ont été identifiés à l’aide de la traduction en langue française de la forme à 40 items du DSQ [7]. Cet instrument explore 20 mécanismes de défense (deux items par défense) regroupés en trois facteurs : matures, névrotiques et immatures. Le mode de cotation est de 9 degrés (échelle Likert) allant de pas du tout d’accord jusqu’à tout à fait d’accord. Trois études ont étudié la validité de façade. Dans la première étude [8], un accord a été observé pour 74 % des items mais les auteurs n’ont pas donné les précisions. Les auteurs de la deuxième étude [9] indiquent que quelques items n’ont pas fait l’objet d’un consensus parfait. Cependant, l’attribution de tels items à une défense particulière a été faite sur d’autres critères évaluant la validité de construit et la validité critériée. Enfin, dans la troisième étude [10] ont réalisé la première étude publiée de validité de façade. La validité de façade excellente. Ce questionnaire a été le plus utilisé dans les études empiriques.
1.2
L’Échelle de résilience de Wagnild & Young [7]
Les réponses aux items se situent entre 1 (accord) et 7 (désaccord). On demande au participant de lire l’énoncé et de marquer le chiffre qui correspond le mieux à ce qu’il pense de lui. Un score global est calculé et deux autres scores pour les dimensions «comportements» et «acceptation de la vie». Plusieurs études de petites envergures effectuées au début des années 90, mais en 1993, l’Échelle de résilience a été testée sur une population de 810 adultes d’âge moyen et d’âge plus avancé dont 48 % étaient des hommes. Les mesures de validation incluaient la dépression, la morale et la satisfaction. La validité de contenu (0,62) et la fidélité (0,91) ont démontré des scores acceptables comme les études précédentes. Le coefficient alpha de Cronbach s’est situé à 0,82. L’analyse factorielle a indiqué deux facteurs principaux, qui ont été nommés «l’acceptation de soi et de la vie».
1.3
Brief COPE.
Le questionnaire utilisé dans cette recherche est la traduction française du Brief COPE [11] Cet instrument est une version abrégée de l’Inventaire COPE [4]. Il comprend 14 échelles évaluant toutes des dimensions distinctes du coping. Chacune de ces échelles comprend 2 items (28 items au total). Le choix des réponses proposées est : «pas du tout», «de temps en temps», «souvent» et «toujours» et leur score respectif s’établit de 1 à 4. La traduction a été faite en France et validée sur cette population [7]. Deux études ont été
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effectuées pour la validation. Cet outil présente de bonnes qualités psychométriques dans sa version situationnelle. Sa structure factorielle est congruente avec celle attendue. Quant à la validité externe, l’étude des relations entre perceptions du contrôle de la situation et de l’évolution de celle-ci, et stratégies mises en place montre que la perception d’un faible contrôle est associée à des stratégies décrites comme dysfonctionnelles, alors que la perception d’un contrôle important ou d’une évolution favorable est associée à des stratégies décrites comme fonctionnelles.
Résultats Dix-neuf adolescentes âgées entre 12 ans et 18 ans, ont participé à notre recherche. L’âge moyen était de 189 mois (15 ans et 10 mois; ÉT = 20,58). Les âges des participantes étaient répartis entre 152 mois (12 ans et 8 mois) et 214 mois (17 ans et 10 mois). Le niveau socioéconomique de la famille de six participantes était faible, pour douze autres, il était moyen et une seule vivait dans une famille de niveau socioéconomique élevé. Quatre participantes ont vécu dans un environnement familial de négligence. Douze adolescentes ont rapporté la présence de maladie mentale du côté familial maternelle et paternel. Tous les abuseurs sexuels étaient des hommes, le plus jeune avait 13 ans et le plus âgé avait 60 ans (M = 34,11; ÉT = 16,12). Onze jeunes ont été victimes d’un ASE intrafamilial (père, beau-père, frère, demi-frère ou cousin), huit ont vécu un ASE extrafamilial. Une seule adolescente a connu les deux situations, intrafamiliale et extrafamiliale, soit le père, le cousin et trois hommes connus de la famille. Sept participantes ont rapporté entre un et trois épisodes (M = 1,8) et le plus long intervalle entre deux épisodes était deux ans et le plus court six mois. Les autres participantes (12) ont été victimes d’AS sur une base continue. La plus courte période rapportée est six mois et la plus longue est 8 ans. La plus longue période d’AS sans arrêt a été révélée par une participante qui a été victime pendant huit ans d’attouchements et d’exhibitionnisme de la part de son beau-père. L’âge de survenue de la première agression est répartie entre trois ans et 16 ans (M =10,16; ÉT = 4,21). Seize adolescentes ont rapporté des attouchements, quatre la pénétration, quatre le viol, quatre d’entre elles ont signalé la présence de violence physique, trois de pornographie, une de l’utilisation d’internet, deux d’exhibitionnisme et enfin deux avec menace de mort, de tuer la famille, etc. La comparaison entre les statuts «avec diagnostic» et «sans diagnostic» et l’âge de survenue n’est pas significative au test de Mann-Withney (2 =.318). Échelle de résilience. Les scores globaux varient de 25 à 175. Les scores obtenus dans notre cohorte se situent entre 59 et 156 (M = 127,16; ÉT = 25,02), à la dimension «compétence» ils se répartissent entre 35 et 112 (M = 91,8; ÉT = 19,08) et à la dimension «acceptation de la vie» ils sont entre 18 et 46 (M = 35,2; ÉT = 8,7). Dans une recherche précédente auprès d’étudiants québécois, la moyenne du score global obtenu était de 135,88 (É.T.= 18; la dispersion allait de 135 à 176). Les résultats ont aussi démontré que sept items n’avaient pas reçu la cotation 1 («totalement en désaccord»; items 2, 4, 9 10, 17 et 24) deux items avaient été cotés de 3 à 7 (items 15, 16) et un item de 4 à 7 (item 23). Brief COPE. Les résultats obtenus dans l’évaluation du coping montrent que les adolescentes utilisent en moyenne huit types de stratégies (M=8,4) pour faire face au traumatisme de l’ASE. La stratégie la plus utilisée est la distraction (84 %) et celle la moins utilisée est la religion (16 %). D’autres stratégies sont régulièrement utilisées par les participantes : l’acceptation et le soutien instrumental (79 %), le coping actif, l’expression des sentiments et le déni (74 %), le soutien émotionnel, le blâme et le désengagement (68 %). Dans sa recherche prédisant l’expérience de stress chez les adolescentes, Michelle Dumont [12] a rapporté que les adolescentes se sentent davantage menacées par le stress chronique que les adolescents et elles utilisent plus souvent des stratégies adaptatives cognitives ou de recherche de soutien social. Ses résultats indiquent aussi que l’évitement prédit la fréquence et la sévérité du stress à l’adolescence. Résilience et coping. En ce qui a trait à la résilience et le coping, les résultats nous révèlent que les quatre adolescentes ayant obtenu les scores de résilience les plus élevés (145 et plus), utilisent (toujours ou de temps en temps) en moyenne huit stratégies de coping. Parmi celles-ci, deux participantes avec des scores de résilience homologues (152) et manifestant des symptômes post-traumatiques sans toutefois répondre à tous les critères ÉSPT, utilisent sept stratégies de coping (m=7) alors que les deux autres avec des scores de résilience de 156 et 146 et diagnostiquées ÉSPT, ont recours en moyenne à huit stratégies différentes (m=8,3). Par ailleurs, l’expression des sentiments est corrélée positivement et significativement avec la dimension acceptation de la résilience (corrélation r de Pearson = .52 p=,022). Nous observons de plus, trois tendances : le blâme est relié négativement à la dimension acceptation (corrélation de Pearson = -4,25 p=,070), la distraction associée positivement au score global de résilience (corrélation r de Pearson = .43 p=,06) et à la dimension compétence (corrélation r de Pearson = .46 p=,047). En présence d’un plus grand nombre de participants, ces corrélations auraient été significatives.
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Discussion et conclusion Les résultats de cette étude permettent de constater que les variables reliées directement à l’AS (âge de survenue, type d’AS, lien avec l’agresseur et durée de l’AS) ne sont pas associées significativement au statut «sans diagnostic ÉSPT» et «avec diagnostic ÉSPT». Trickett et ses collaborateurs [12] rapportent que même si les variables reliées à l’AS ont reçu une attention considérable dans les écrits scientifiques depuis les années ’80, les résultats variaient toujours d’une recherche à l’autre. De plus, les auteurs ont suggéré que les différences dans la nature et la sévérité de l’AS provoqueraient différents degrés de traumatismes qui en retour auraient une incidence sur la variabilité des séquelles [13]. Les résultats de notre étude montrent cependant des corrélations entre la résilience et les stratégies de coping qui, selon Lazarus & Folkman [2], sont d’importants modulateurs des conséquences liées à des évènements stressants. Nous avons observé chez les adolescentes résilientes que l’expression des sentiments est positivement associée à la dimension de la résilience «acceptation de la vie». Ainsi, le fait de pouvoir exprimer ses sentiments favorise leur adaptation en les aidant à accepter, à faire du sens avec le traumatisme de l’AS. Pour Lengua et Long [14], la catharsis et le fait de ressentir des émotions douloureuses peuvent être néfastes si l’acquisition d’habiletés pour les gérer ne se fait pas simultanément ou préalablement. En fait, le coping «expression des sentiments» est considéré comme étant souvent peu fonctionnel, car il est associé avec une détresse émotionnelle chez la personne qui ne parvient pas à évacuer ses sentiments. Il est souvent réalisé au détriment d’un effort pour un coping plus actif. Cependant, il peut être transitoirement fonctionnel, par exemple, pendant la phase de deuil [11]. Il est donc fort possible que pour les adolescentes de l’étude l’expression des émotions soit utilisée au début de leur adaptation à la situation traumatisante. Cependant, la seule stratégie de coping actif qui s’est avérée avoir une tendance significative avec le score global de la résilience et la dimension «compétence» est la distraction classée parmi le coping actif et efficace parce qu’il impliquait un engagement avec une pensée ou une activité sans relation avec le stresseur et qui avait comme but de diminuer l’intensité des émotions [15]. À la décharge de ces chercheurs ci-haut mentionnés, il n’en demeure pas moins que l’expression des sentiments entrave le coping actif. Une autre stratégie d’adaptation qui a démontrée une tendance significative avec la dimension «acceptation de la vie» est le blâme. Ces deux variables sont corrélées négativement, le fait de se blâmer nuit à l’adaptation des adolescentes. Les adolescentes qui acceptent davantage avoir été victime d’AS se perçoivent plus résilientes. Cependant, se blâmer par rapport aux AS peut être une réaction normale momentanément dans un contexte abusif. Feiring & Cleland [16] ont démontré que les enfants avaient une tendance décroissante à se blâmer et à attribuer le blâme à l'abuseur au fil du temps. De plus, le fait que nous ayons utilisé un questionnaire peut avoir une incidence sur les résultats tel que l’a démontré cet auteur : les enfants semblent s'attribuer plus de blâme quand ils répondent aux questionnaires que lorsqu’ils sont en entrevues cliniques. Et enfin, dans notre étude, les attributions de blâme à l'abuseur n'ont pas été significativement associées aux symptômes, corroborant ainsi les résultats de leur recherche.
Références [1]
McClure, F., et al. (2008). Resilience in sexually abused women. Journal of Family Violence, 23(2), 8188. [2] Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal, and coping. New York, Springer. [3] Ionescu, S., & Jourdan-Ionescu, C. (2011). Entre enthousiasme et rejet. Bulletin de psychologie, 63(6), no. 510, 401-403. [4] Carver, C. S., et al. (1989). Assessing coping strategies. Journal of Personality and Social Psychology, 56(2), 267-283. [5] American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4e éd. Rev.). Washington, DC : Auteur. [6] Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1(2), 165-178 [7] Andrews, G., et al. (1993). The Defense Style Questionnaire. Journal of Nervous Mental Disease, 181, 246-256 [8] Chabrol, H. & Brandibas, G. (2000). Le questionnaire de style de défense à 40 items. Encéphale, 26, 7879. [9] Chabrol, H., et al. (2005). Validity study of the DSQ-40 (Defense style questionnaire, 40 item version). L’encéphale, 31(3), 385-386 [10] Bonsack, C., et al. (1998). The french version of the defense style questionnaire. Psychotherapy and Psychosomatics, 67, 24-30.
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[11] [12] [13] [14] [15] [16] [17]
Muller, L., & Spitz, E. (2003). Évaluation multidimensionnelle du coping : Validation du Brief COPE sur une population française. L’encéphale, XXIX (cahier 1), 507-518. Dumont, Michelle. Expérience de stress à l’adolescence. International Journal of psychology, 35(5), 194206. Trickett, et al. (1997). Characteristics of sexual abuse trauma and the prediction of developmental outcomes. Dans D. Cicchetti & S. L. Toth (Éds). Developmental Perspectives on trauma. New York : University of Rochester Press. Trickett, et al. (2011). The impact of sexual abuse on female development. Development and Psychopathology, 23453-476. Lengua, L. L., & Long, A. C. (2002). The role of emotionality and self-regulation in the appraisal – coping process. Applied Developmental Psychology, 23, 471-493. Connor,-Smith, J. K., et al. (2000). Responses to stress in adolescence. Journal of Consultating and Clinical Psychology, 68, 976-992. Feiring, C., & Cleland, C. (2007). Childhood sexual abuse and abuse-specific attributions of blame over 6 years following discovery. Child Abuse & Neglect, 31, 1169-1186.
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Coping and survival strategies during repression – the romanian former political prisoners’ experience Macarie G.F.1, Doru C.2, Voichita T.A.3 1
”Grigore T. Popa” University of Medicine and Pharmacy, Iasi, 16 Universitatii Str., Iasi 700115 (ROMANIA) ICAR Foundation, Bucharest (ROMANIA) 3 "Politehnica" University of Bucharest, Teacher Training Department, 313 Splaiul Independentei, Bucharest 060042 (ROMANIA)
[email protected],
[email protected],
[email protected] 2
Abstract Numerous studies deal with the explanatory factors and the resources needed for survival and maintaining the psychological health after political repression or collective violence. They are concerned with coping strategies, attachment, as well as historical and social determinants of the development of protective factors [1], [2], or how the effects of repression are moderated by the political involvement and beliefs [3], [4]. In a group of 45 former political prisoners (mean age = 80.5 years) we aimed to reveal the coping styles and the key elements of their survival during political repression (1948-1989). The coping strategies developed by participants were evaluated using the Brief COPE inventory [5], while the biographical interview aimed to find the significant elements related with the survival during repression. Participant’s scores to the Brief COPE scales show a significant presence of active coping and seeking instrumental support dimensions, suggesting their usefulness when confronting difficulties after release (insertion in a changed social environment, finding a job, etc.). Thematic analysis of the narratives identifies a number of key elements in dealing with adversity: beliefs, social or political concerns, perception of social changes after release, the presence of challenges, social activism, professional achievement.Moreover, the flexibility in the choice and the ability to use different strategies appears to be an adaptive aspect in dealing with stressful situations and lived problematic experiences. Keywords: Coping, surviving strategies, adversity, repression, political prisoners.
Introduction The consequences of collective or political violence has been for decades studied, with an emphasis on negative symptoms such as chronic depression, anxiety, sleep disturbances, nightmares and psychosomatic disorders. More recently, the data regarding the explanatory factors for the resources needed for survival and maintaining the psychological health have increased considerably. Among them, we found the studies on Kurdish political prisoners from Turkey [3], [4], considering the effects of repression and the role of the political involvement and beliefs. Also, other authors [6],[7] studied a certain capacity to overcome the difficulties and trauma following Nazi concentration camps, capacity named sense of coherence. Further studies conducted by a group of Finnish researchers [1], [2], on former Palestinian political prisoners gave a good comprehension on how people survive after political repression or collective violence. The later studies are concerned with coping strategies, attachment, sense of coherence and post-traumatic growth. Another concept to consider in the study of reactions on a adversity context is resilience, which generally refers to one’s ability to “cope well with adversity” and “persevere and adapt when things go awry. Resilience helps people deal with stress and adversity... and reach out to new opportunities”[8]. Considering the political repression in the communism regime from Romania, the survivors of the imprisonment and persecutions made a large inventory of the threats, difficulties and traumatic events lived during that era [9], [10], [11]. Still, the development of strategies to cope with the adversive events are not sufficiently clarified. Thereby, the present study intends to unreveal the coping strategies developed by participants and to find significant elements related with the survival during repression.
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Methods Participants are 45 former political prisoners (M = 80.58, SD = 5.03), mostly men (39 from 45), structure representative for the population of former political prisoners, according to historical data. They were subject to imprisonment and to persecution during the political repression during the communism regime (between 1948 and 1964). Data were collected in familiar locations, in 2008-2009. 51.1% of participants graduated high school, while 35.6% completed university studies. About 20% (9 individuals) were arrested during their studies; 6 of them fulfilled their studies after imprisonment. Using a mixed design - quantitative and qualitative, we evaluated the presence of the coping strategies as described by Carver (1997) and searched for significant elements related to the survival during their lifelong experiences. The instruments were an in-depth (biographical) interview and the BriefCOPE inventory [5]. BriefCOPE is an abbreviated version of the COPE inventory [12], perfected to evaluate the coping strategies developed by individuals in stressful situations. This inventory contains 14 subscales of 2 items (outlined in table nr. 1), with a Cronbach alpha coefficient of validity between 0.50 and 0.90. Brief COPE questionnaire is especially useful when time constraints are significant, or when participants have difficulty in concentrating for a long time. Data from the questionnaire were analyzed using SPSS 14.0, being treated in a descriptive manner. The content analysis sought to identify themes in the subjects’ narratives; the selected themes had to hold a significant part in the participants' personal history, and a satisfactory representation of the whole group.
Results 1.1
Descriptives of Brief Cope scores
The data presented in the table 1 indicate that the most frequent coping strategies are the active coping, followed by seeking instrumental support and religion. Scores reported by subjects in the active coping (range 48, M= 5.6) suggest that each of our subjects used at least a few times this strategy. Regarding the use of instrumental support, the mean scores suggest the habit of most participant to frequently appeal to this strategy in a number of problematic life situations. Among the less frequent chosen ways of coping reported we noted the use of drugs or alcohol strategy, with scores not higher than 3 for a subject, meaning that for maximum one question of the two items indicating this dimension the answer was “sometimes”. Further, we found low than average scores on dimensions like humor (M = 3.07), self -blame (M = 3.4) and denial (M = 3.64). Scores variability shows that subjects did not report the maximum possible scores on these scales, indicating a low presence of humor coping strategies, denial and self-blame for the whole group. Table. nr. 1. Descriptives of scores reported on coping dimensions (N = 45, two items scale, range from 2 to 8) Statistics of scores Coping strategies min max Mean SD 1. Active coping 4 8 5.60 1.03 2. Planning 3 7 4.82 1.11 3. Positive reframing 2 7 4.04 1.10 4. Acceptance 2 8 4.53 1.50 5. Humor 2 5 3.07 .75 6. Religion 3 8 5.00 1.34 7. Use of emotional support 2 8 4.82 1.26 8. Use of instrumental support 2 7 5.33 1.16 9. Self-distraction 2 7 4.93 1.03 10. Denial 2 7 3.64 1.09 11. Venting 2 7 4.47 1.23 12. Substance use 2 3 2.33 .47 13. Behavioral disengagement 2 6 4.00 1.06 14. Self-blame 2 6 3.40 .93
1.2
Cathegories and themes related with adversity conditions (biographical data)
Personal beliefs. A significant number of subjects (51.1%) refer to their beliefs as relevant in the period prior to arrest; during imprisonment the proportion decreases to 33.3% of the total group, proportion which
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remains relatively constant in subsequent periods, with a slight recovery after 1989 (fall of the communist regime). Political interest. A similar trend seems to be followed: a relative decrease of this interest in the period after the liberation could be related to the impossibility to activate or to discuss matters of this kind with the close ones. Expectation of the arrest: Two thirds of the participants in our study were expecting to be arrested, which could indicate us that they were considering the deployment of socio-political events, and they were aware of being under their incidence. Confronting the social and political changes. The confrontation with the environmental changes seems to occur even before incarceration, period during which the Communist party has already gained influence over all the social or decisional segments. Most assessments assert the difficulties to support changes occurring during arrest and imprisonment, when it was a direct confrontation with the repressive and coercive environment, the individual having to live in a way totally different from the known one. Persecutions are appreciated as significant in the period of imprisonment and after the liberation. During imprisonment, the references include: confinement, lack of privacy, disregard for any personal rights, etc. Considering the post-release period, the persecutions include administrative barriers when applying for a job, police citation; the subjects assess the persecutions as difficult to avoid. The possibilities for avoidance were related to the nature of the profession, to the security staff from the administrative region, and the personal capacity to anticipate the actions of the repressive actions. Solicitations (challenges, demands) from the environment and the assessment of life situations suggest a considerable variability and the absence of a typical pattern for the adversity situations encountered (historical data assert that the repression was not organized in a unitary way). The positive or negative assessment of life situations seems to be related to the resources available at the time of liberation, but also to the duration of incarceration. As major sources of support are mentioned: the profession, the family, the people encountered, and also a certain way of approaching the situations they were confronted with. The same issues are often the source of the most important difficulties during their lives, when the expected support does not become a resource.
Discussion The results show a significant presence of types of active coping and seeking instrumental support, potentially explained by the specificity of this type of coping, and the social political context necessary after release. Having faced numerous restrictions to further studies or employment, often facing persecution against them or family of origin, former political prisoners had to adapt to the new administrative system. They endeavored substantially to continue their education, facing numerous bureaucratic barriers. Moreover, job search involved in some cases a waiting period of several months or years, during which they needed the support of relatives or acquaintances and in most cases certain administrative “juggling” to avoid rejection as “undesirable”. All these challenges may require as strategies an active coping or seeking instrumental support, in order to overcome the mentioned difficulties. Among the possible explanations for the extremely low use of substances as a way to cope with difficult situations we can first think to our group characteristics: surviving after many years of adversity, this may be a vital selected population, including the avoidance of health risk factors. We also had to consider the impossibility to buy drugs or alcohol during detention; further, demands and difficulties after release (graduation issue, employment or job maintenance, sometimes persecutions) did not allow the recourse to this means of mitigation of negative psychological states. In very few cases, the use of drugs was mentioned sporadically, mainly because it did not bring any relief to their psychological condition. The affirmation of personal beliefs and the relevance for the individual don’t seem to be affected by repression in the long term; a similar tendency seems to be followed by political interest stated by subjects, when a relative decrease of interest after release may be related to the inability to activate or to discuss this kind of matters with the closest people. Considering the competence to deal with a changed environment, the narrative suggests that a longer imprisonment leads to the development and the constant affirmation of distinct coping strategies; as a consequence, more years of prison demanded the use of these strategies, making the subject more prepared for the adversive environment encountered after release. Concepts like coping and resilience provide some support for this assertion. Thus, every change generates a certain amount of stress, or at least a request to which the body reacts; an eventual success in adaptation will result in a higher capacity to cope with stress [13]. On the other hand, it is described as resilience the characteristic of a person who lived or is living events of traumatic nature or chronic adversity, and proves good adjustment as a result of an interactive process between the individual, the family and its environment [14].
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Conclusion Among the dimensions of coping, the most commonly reported are active coping, seeking instrumental support and religion. As mentioned, these strategies may be required by the characteristics of difficulties and adversity lived during or after imprisonment. On the other hand, the most underrepresented coping strategies are the use of substances, humor, self-blame, and denial. Data from narratives suggest that own values and beliefs were important milestones in the decisionmaking in critical situations or experiences. Moreover, the conditions of adversity and organized repression seem to reinforce the subject’s own beliefs and judgments of a particular fact or event. In a broader acception, the last decades of research show that we can learn to be more resilient by changing how we think about challenges and adversities [8], [15], [16].
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16]
Punamäki, R., Salo, J., Qouta, S. (2005). Adult attachment, posttraumatic growth and negative emotions among former political prisoners. Anxiety, Stress & Coping: An International Journal, Vol. 18(4), Dec 2005. pp. 361-378. Punamäki, R., Kanninen, K., Qouta, S. (2002) The relation of appraisal, coping efforts, and acuteness of trauma to PTS symptoms among former political prisoners. Journal of Traumatic Stress, Vol. 15(3), pp. 245-253. Basoglu, M., Mineka, S., Paker, M., Aker, T., Livanou, M., Gök,S. (1997), Psychological preparedness for trauma as a protective factor in survivors of torture, Psychological Medicine, 27, pp.1421-1433. Basoglu, M.., Parker, M., Paker, Ö., Özmen, E., Marks, I., Incesu, C., Sahin, D., Sarimurat, N. (1994). Psychological effects of torture: A comparison of tortured with matched nontortured political activist in Turkey, American Journal of Psychiatry, 151, pp.76-81. Carver, CS (1997), You want to Measure Coping But Your Protocol's Too Long: Consider the Brief COPE, International Journal of Behavioral Medicine, Vol. 4, Issue 1, 9p., p.92. Antonovsky, A. (1979). Health, Stress and Coping. San Francisco: Jossey-Bass. Antonovsky, A (1987), Unraveling the mystery of health, San Francisco: Jossey-Bass. Masten, A. S., & Coatsworth, J. D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53(2), pp.205–220 Macarie G.F. (2004), Memoria represiunii politice din perioada comunistă, in A. Neculau (coord.), Viata cotidiană în comunism, Iasi, Polirom, pp.306-320. Bichescu D. (2004), Aspecte ale vietii cotidiene si strategii de adaptare după eliberarea din detentia politică până în 1989, in A. Neculau (coord.), Viata cotidiană în comunism, Iasi, Polirom, pp.289-306. Novac, Cătălina (2005), Long-term Traumatic Experiences of Imprisonment and Their Impact on the Well-being of Political Prisoners of the Romanian Gulag, PhD thesis, University of Rochester. Carver, C.S., Scheier, M.F., & Weintraub, J.K. (1989). Assessing coping strategies. A theoretically based aproach. Journal of Personality and Social Psychology, 66, pp.184-195 Cosman, Doina (2010), Psihologie medicală, Iaşi, Ed. Polirom Ionescu S., Le domaine de la résilience assistée, in S. Ionescu (dir.) Traité de résilience assistée (2011), préface de Boris Cyrulnik, Quadrige/Presses Universitaires de France, Paris. pp.3 . Reivich, K., & Shatté, A. (2002). The resilience factor. New York: Broadway Books. Schneider, S. (2001). In search of realistic optimism. American Psychologist, 56 (3), 250–261
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Stress, coping and quality of life of Belgian parents of children with autism sepctrum disorder Nader-Grosbois N.1, Cappe E.2 1
Université Catholique de Louvain, Institut de recherche en Sciences Psychologiques, (Belgique) Université Paris Descartes, Institut de Psychologie (France)
[email protected],
[email protected] 2
Abstract Based on the integrative psychology and multifactorial health model of Bruchon Schweitzer (2002), an empirical study was conducted among parents of Belgian children with autism spectrum disorders. During the diagnostic process and throughout the education of their child, parents are faced with situations of stress and burdened parenting threatening family well-being. Several questionnaires were completed online or in paper form by the parents in this case: the Appraisal of Life Event Scale [9] assessing perceived stress, Perceived Control Scale (adapted from Cancer Locus of Control Scale, Cousson-Gélie, 1997), Perceived Social Support Questionnaire [5], the adaptation of the Ways of Coping Checklist Revisited, [6] to assess coping strategies, focusing on the problem, on the emotions or seeking social support and the Scale of Quality of Life for parents of children with ASD [8].An analysis of their perceived stress, their control, the type of social support and coping strategies, allows us to understand their perception of subjective quality of life and their psychological needs and family support. Key-words: coping, autism, quality of life
Introduction Notre étude se penche sur la qualité de vie et les processus d’adaptation de parents belges ayant un enfant présentant par un trouble du spectre de l’autisme (TSA) et sur les facteurs de risque et de protection en jeu. Des études ont montré que les parents d’enfants TSA sont plus sujets à la dépression, au stress à différents moments de la vie de leur enfant, vu la confrontation à de multiples problèmes au quotidien et pour son éducation. Ceux-ci sont difficiles à gérer et induisent un sentiment de perte de contrôle. Les parents utilisent des stratégies de coping pour faire face à ce stress. Le soutien social de l’entourage et des professionnels peut contribuer à leur qualité de vie (QV). Celle-ci peut être influencée par des facteurs individuels et environnementaux. La littérature s’est développée ces dernières années à ce sujet alors que les parents expriment depuis longtemps leur souffrance liée au handicap de leur enfant [1], [2]. Cette étude se base sur le modèle intégratif et multifactoriel de Bruchon-Schweitzer [3], développé en psychologie de la santé, fondé sur une conception transactionnelle du stress de Lazarus et Folkman [4]; stress qui peut provenir de causes individuelles, familiales ou sociales (Fig. 1). Ce modèle intègre trois types de variables: (1) les prédicteurs comprenant les antécédents avant le stresseur (dont les caractéristiques des individus) et les déclencheurs de l’apparition du stress; (2) les processus transactionnels ou stratégies cognitives, émotionnelles et comportementales de la personne pour faire face à la situation stressante comportant: (a) l’évaluation primaire du stress, (b) l’évaluation secondaire des ressources personnelles (ou contrôle perçu) et des ressources sociales (ou soutien perçu) ainsi que (c) les stratégies de coping; (3) les issues adaptatives se reflétant par l’état somatique et émotionnel de la personne ou sa QV. Les processus transactionnels jouent un rôle modérateur ou médiateur sur les relations entre les prédicteurs et les issues adaptatives. Concernant le contrôle perçu, dans ce cadre, nous distinguons la perception de contrôle sur le trouble, sur l’évolution de développement de l’enfant et les croyances irrationnelles à propos du trouble. Le soutien social perçu concerne le sentiment de la personne d’être aidée, protégée et valorisée par son entourage, ou pas [5]. La personne est invitée à estimer la disponibilité du soutien social par le nombre de personnes sur qui elle peut compter ainsi qu’à apprécier le degré de satisfaction à propos du soutien. Ils se différencient en «soutien émotionnel» par le réconfort, l’expression d’affects positifs à son égard; en «soutien informatif» par l’apport de
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connaissances face à un problème; en «soutien d’estime» par la rassurance quant à ses compétences lors de doute; et en «soutien matériel et financier» [5]. Lorsque la personne met en œuvre des stratégies de coping, elle exerce des «efforts cognitifs et comportementaux, constamment changeants, destinés à gérer les existences externes et/ou internes spécifiques qui sont perçues comme menaçant ou débordant les ressources d’une personne» [4]). Celles-ci sont déterminées par les caractéristiques du contexte et peuvent changer dans le temps [3]. On distingue le coping «centré sur le problème» par la recherche de ressources diverses dont l’information, le soutien, «centré sur l’émotion» par l’expression et la régulation des émotions engendrées par la situation, et induisant le déni ou l’évitement; et enfin «la recherche de soutien social» [6], [7].
Fig. 1. Modèle intégratif et multifactoriel adapté à la situation des parents d’un enfant TSA [8]
L’étude vise à examiner les questions suivantes. Quels sont les facteurs individuels et environnementaux qui font varier la perception du stress, du contrôle, du soutien, des stratégies de coping et de la qualité de vie des parents ayant un enfant TSA? La qualité de vie des parents ayant un enfant TSA varie-t-elle en fonction de leurs perceptions du stress, du contrôle, du soutien social et de leurs stratégies de coping?»
Méthode 1.1
Participants
31 parents (27 mères, 4 pères) âgés de 28 à 55 ans (M = 41 ; ET = 6.5) ont participé à l’étude. Leurs enfants TSA (25 garçons, 6 filles) sont âgés entre 35 et 261 mois (M = 125 ; ET = 63).
1.2
Instruments
Une estimation des besoins de soutien psychologique et de conseils, d’aides concrètes et de partage d’expériences ou collaboration (max = 66) est obtenue par une échelle de 22 items. Une estimation de satisfaction concernant l’annonce du diagnostic, les prises en charge, le suivi médical et thérapeutique après l’annonce, la scolarité de l’enfant, le partage des tâches au sein du couple, l’aide apportée par les associations et les relations avec les professionnels est obtenue au moyen d’une échelle de 14 items (max = 30). L’échelle ALES (Appraisal of Life Event Scale [9]) mesure le stress perçu selon que l’expérience est perçue comme une menace, une perte (max = 50) ou comme un défi (max = 30). Le CLCS (adaptation de la Cancer Locus of Control [10]) évalue degré de contrôle perçu des parents concernant l’apparition du TSA, l’évolution du développement de l’enfant et les croyances irrationnelles. Le QSSP (Questionnaire de Soutien Social Perçu [5]) évalue le soutien social perçu en différenciant les soutiens émotionnel, informatif, d’estime, matériel et financier. La WCC-R (Adaptation du Ways of Coping Checklist Revisited [6]) mesure les stratégies de coping des parents «centré sur le problème», «centré sur l’émotion » et « la recherche de soutien social».
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Une échelle de qualité de vie [7] évalue les conséquences du TSA dans 7 domaines : activités et relations quotidiennes, professionnelles, sociales, familiales et de couple, relations avec l’enfant TSA, bien-être, épanouissement personnel.
1.3
Procédure
Le recrutement s’est réalisé par une information et un appel aux parents par l’intermédiaire de la présidence de l’Association de Parents pour l’Epanouissement des Personnes avec Autisme, par affichage dans des services spécialisés assurant des suivis d’enfants TSA, par un stand d’information à des journées d’études ainsi que par une demande postée sur Facebook «Autisme TED Belgique: groupe d’entraide». Une fiche signalétique relative aux informations sociodémographiques et d’anamnèse et les cinq questionnaires ont été intégrés en un dossier, envoyé sous format papier ou rendu accessible en Limesurvey, à l’intention des parents ayant donné leur consentement.
Résultats 1.4
Processus
Le tableau 1 présente les statistiques descriptives des processus étudiés. Le score de satisfaction globale (relative aux informations sur le TSA, à l’évolution de l’enfant, à l’intervention, à l’écoute, l’aide et aux relations avec les professionnels) ainsi que le score en besoins varient beaucoup selon les parents. Tableau 1. Moyennes, écart-type, min, max des scores aux échelles M 28.5 17
ET 14.5 6
Min 7 0
Max 61 28
menace/perte défi
53.6 47.9
20.5 27.1
22 0
100 100
apparition TSA évolution TSA croyances irrationnelles
8.9 76.15 11.41
13.7 18.6 20.1
0 38 0
53.3 100 77.8
5 4 10 1.7 26.1
3.8 4 6 2.5 7.9
0 0 0 0 0
15 13 28 10 36
problème émotions recherche soutien social
68 47 64.7
19.2 22.1 24.8
26 7.4 0
100 81.5 100
Globale Quotidien Profession Social Famille-couple Relations-enfant TSA Bien-être Epanouissement
51.7 63.7 49.3 52.6 54.7 40.1 50.9 31.6
12.6 17.1 33.8 18.5 13.1 22.3 19.2 23.1
23.6 27.8 0 6.7 30 0 9.8 0
85.5 92.6 100 85 91.7 76.2 98.5 100
Besoins (max = 66) Satisfaction (max = 30) Perception du TSA (%) Contrôle (%)
Soutien Nombre de personnes
émotionnel informatif estime matériel et financier (%) Satisfaction
Coping (%)
Impact TSA sur qualité de vie (%)
Des comparaisons par t pairés de Student et des analyses de variance des moyennes des sous-scores relevant des cinq échelles mettent en évidence certaines différences significatives. Préalablement, les sous-scores à ces échelles ont été transformés en pourcentage. Concernant le stress perçu, le TSA n’est pas plus perçu comme une menace, une perte que comme un défi. Concernant le contrôle perçu, la perception de contrôle est plus élevée pour l’évolution du développement de l’enfant que pour l’apparition du TSA et les croyances irrationnelles. Concernant la perception du soutien, le nombre de personnes disponibles varie beaucoup selon le type de soutien et les parents : c’est le soutien d’estime qui est le plus présent. La satisfaction du soutien varie très fort selon les parents. Concernant le coping, la stratégie de coping centrée sur les émotions est moins mobilisée que les stratégies de coping centré sur le problème et de recherche de soutien social. Quant à la QV des parents, elle varie significativement selon les domaines. La QV des activités quotidiennes est plus atteinte que celle relative aux activités professionnelles, aux relations sociales, aux relations familiales et de couple, au bien-être et à l’épanouissement personnel. La QV des relations sociales est
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plus touchée que celle relative à l’épanouissement personnel. La QV des relations familiales et de couple est plus affectée que celle relative aux relations avec l’enfant, et à l’épanouissement personnel. La QV relative au bienêtre est plus atteinte que celle relative aux relations avec l’enfant TSA et à l’épanouissement personnel. Bref, l’épanouissement personnel semble être le domaine le moins affecté par la présence du TSA de l’enfant.
1.5
Variation des processus en fonction des caractéristiques de l’enfant
Des analyses de variance ont mis en évidence que la QV en relations familiales varie en fonction de l’autonomie de l’enfant; la QV en activités quotidiennes varie en fonction de la communication de l’enfant, de son usage d’un système alternatif de communication ainsi que de sa pratique de loisirs ; la QV en épanouissement personnel varie en fonction de la pratique de loisirs. Le soutien matériel et financier varie en fonction de la propreté de l’enfant le jour et la nuit. La propreté la nuit fait aussi varier le score de besoins, le score de satisfaction et le TSA perçu comme une menace ou perte. Le coping centré sur le problème varie selon la présence de troubles associés.
1.6
Variation des processus en fonction des caractéristiques des parents
La répartition des tâches fait varier le score de satisfaction, le coping centré sur les émotions, la QV globale, en activités quotidiennes et en relations sociales. Les revenus font varier le score en besoins, le soutien matériel et financier, la satisfaction du soutien, le coping centré sur le problème, la QV globale, en activités quotidiennes et en relations sociales. Le fait de considérer leurs revenus comme suffisants fait varier le score en besoins et le score de satisfaction, la QV globale et en bien-être. Le temps de travail fait varier la QV en activités professionnelles. Les changements professionnels font varier le contrôle perçu sur l’évolution de l’enfant TSA, la QV en activités professionnelles. Le fait d’être membre d’associations de parents fait varier la perception de contrôle sur l’évolution de l’enfant TSA, la QV en activités professionnelles, en relations familiales et de couple.
1.7
Variation des processus selon la procédure diagnostique et le parcours de l’enfant
La personne ou l’équipe qui établit le diagnostic fait varier la perception de contrôle sur l’évolution de l’enfant TSA. Le fait d’avoir des doutes fait varier le coping par recherche de soutien social. Le fait d’avoir son mot à dire lors de l’intervention précoce fait varier le score en satisfaction, la perception du TSA comme une menace ou perte, la QV en activités quotidiennes et en bien-être. Le fait d’avoir son mot à dire pour la scolarisation de l’enfant fait varier le score en satisfaction, le coping centré sur les émotions, la QV globale, en activités quotidiennes et en relations sociales. Le fait de considérer la scolarité adaptée à leur enfant fait varier le score de satisfaction, les soutiens d’estime et informatif.
1.8
Liens prédictifs des processus sur la qualité de vie
Des analyses en régression montrent des liens prédictifs suivants. L’âge de la première intervention et la perception de contrôle sous forme de croyances irrationnelles expliquent 57% de la variance du soutien d’estime. L’âge de la première intervention et la perception de contrôle sur l’évolution de l’enfant explique 54% de la variance du soutien informatif. Le temps de scolarisation de l’enfant explique 19% de la variance du soutien émotionnel. Le score de besoins, la perception du contrôle sur l’évolution de l’enfant et le temps de scolarisation explique 62% du coping centré sur le problème. Le soutien émotionnel explique 24% du coping centré sur les émotions. La perception de contrôle sur l’évolution de l’enfant explique 40% de la variance du coping centré sur la recherche de soutien social. Le score en besoins explique 33% de la variance de la QV globale. Par domaine, la QV par domaine est prédite par des variables plus spécifiques. Le score en besoins, la perception du contrôle sous forme de croyances irrationnelles et de fréquence de scolarisation explique 78% de la variance de la QV des activités quotidiennes. Le coping centré sur le problème explique 19% de la variance de la QV des activités professionnelles. Le score en besoins explique 28% de la variance de la QV des relations sociales. La perception du contrôle sur l’évolution de l’enfant, l’âge des parents et le temps de scolarisation explique 51% de la variance de la QV des relations familiales et de couple. La fréquence de scolarisation explique 33% de la variance de la QV des relations avec l’enfant TSA. Le score en besoins, la perception du TSA de l’enfant comme une menace ou perte explique 70% de la variance de la QV en bien-être. Le coping centré sur le problème, l’âge de l’enfant et la perception du TSA de l’enfant comme une menace ou perte explique 76% de la variance de la QV en épanouissement personnel. Pour conclure, les professionnels doivent considérer les besoins, le parcours d’intervention et de scolarisation, pour soutenir la perception de contrôle sur l’évolution de l’enfant, le coping centré sur le problème et la qualité de vie des parents dans plusieurs domaines.
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Références [1]
Cappe, E., Bobet, R., & Adrien, J.-L. (2009). Psychiatrie sociale et problèmes d’assistance : qualité de vie et processus d’adaptation des parents d’un enfant ayant un trouble autistique ou un syndrome d’Asperger. La Psychiatrie de l’enfant, 52(1), 201-246. [2] Cappe, E., Wolff, M., & Adrien, J-L. (2009) Qualité de vie et ajustement des parents d’un enfant ayant un trouble envahissant du développement. In N. Nader-Grosbois (Ed.). Résilience, régulation et qualité de vie: concepts, évaluation et intervention (pp. 231-236). Louvain-la-Neuve: Presses universitaires de Louvain. [3] Bruchon-Schweitzer, M. (2002). Psychologie de la santé. Modèles, concepts et méthodes. Paris: Dunod. [4] Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer. [5] Koleck, M. (2000). Rôle de certains facteurs psychosociaux dans l’évolution des lombalgies communes. Une étude semi-prospective en psychologie de la santé. Thèse de doctorat inédite, Université de Bordeaux 2. [6] Cousson, F., Bruchon-Schweitzer, M., Quintard, B., Nuissier, J., & Rascle, N. (1996). Analyse multidimensionnelle d’une échelle de coping: validation française de la W.C.C. (ways of coping checklist). Psychologie française, 141(2), 155-164. [7] Cappe, E. (2011). Évaluation de la qualité de vie des parents d’enfants avec autisme. In J.-L. Adrien, & M.-P. Gattegno (Eds.), Autisme de l’enfant, évaluations, interventions et suivis (pp. 87-112). Wavre: Éditions Mardaga. [8] Cappe, E. (2009). Qualité de vie et processus d’adaptation des parents d’enfants ayant un trouble autistiques ou un syndrome d’Asperger. Thèse inédite Université Paris Descartes, Paris. [9] Ferguson, E., Matthews, G., & Cox, T. (1999). The Appraisal of life events (ALE) scale: Reliability, and validity. British Journal of Health Psychology, 4, 97-116. [10] Cousson-Gélie, F. (1997). L’évolution différentielle de la maladie et de la qualité de vie de patientes atteints d’un cancer du sein: rôle de certains facteurs psychologiques, biologiques et sociaux. Thèse de doctorat inédite, Université Victor Segalen, Bordeaux.
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Critical discourses on resilience: Exploring alternatives strategies used by young people at-risk Gomes Pessoa A.S.1, Coimbra Libório R.M.1, Bottrell D.2 1
Universidade Estadual Paulista, São Paulo (BRAZIL) Victoria University, Melbourne (AUSTRALIA)
[email protected],
[email protected],
[email protected] 2
Abstract The concept of resilience is often situated in a dominant discourse that reflects medical and developmentalist epistemology, in Western models, with the ideology of white people, and middle class hegemonic norms. Behavior that falls outside of the “normal”, or what is “socially acceptable”, is associated with riskiness and tacitly if not explicitly labeled as pathological, and then, not resilient. However, the context of social injustice of many young people at-risk can have drastic effects on them. When we offer institutions such as schools that do not understand their needs, they may refuse our services and some of them may engage in antisocial activities, since they are looking for personal validation, pathways to recognize themselves, and places and organizations that contribute to the building of their social identity. This paper analyses how the denial of support and resources for the wellbeing of young people can lead them to situations that are socially unacceptable, such as sexual exploitation and drug trafficking. The main argument is that these activities, in the absence of conventional mechanisms, may bring some benefit to the subjects. Benefits may be in material conditions, though strongly marked by issues of social inequality; or subjective, in gaining relationships with people outside the normative places and institutions for young people. Unconventional circumstances produce unconventional attitudes that are expressed in alternative forms of resilience. Keywords: resilience, adolescents, sexual exploitation, drug trafficking
Epistemological issues on resilience theory Although there are different assumptions about the concept of resilience and its implications in the human development, the main concern is to understand what makes people deal with hard situations and still show personal positivity even when the circumstances are unfavorable. Based on this understanding, the proposal of this paper is to problematize aspects involved in resilience processes for adolescents involved in drug trafficking and sexual exploitation In general, resilience has been conceptualized as psychological capacity to deal with positively problematic situations, including social issues (poverty, natural disasters, lack of resources) and concerning to subjectiveness (trauma, history of violence, disabilities, etc.). Bolzam & Gale [1] describe the studies on resilience in recent decades and show us "four waves" of investigation, which can be understood as explanatory models that supported the researches. Such movements reveal theoretical propositions ranging from more static positions, once resilience is conceived as a personality trait, and therefore hereditarily assigned as a mark of the individual, even speeches that overvalue social issues such as producing resilience. We stand opposed to theoretical perspectives that claim that resilience is related exclusively to biological attributes. We define emphatically that resilience is a social construction process. It means that the offering of protective and useful resources can contribute to minimize the negative effects of challenging contexts. Thus, our proposal is to discuss the social aspects that collaborate in the social construction of resilience, once we understand that the required resources for the subjective strengthening are extracted from the context, including interpersonal relationships, social programs, public policy and culture itself. The approach of Canadian researcher Michael Ungar inspires us. He emphasizes in his work the role of community and cultural issues to show how children and adolescents at-risk navigate through pathways into resilience. It changes the focus on the individual and allows us to create a systematic evaluation about the role of the society in promoting resilience [2] [3] [4]. Unfortunately, resilience as an academic concept is most often located at a dominant discourse. The knowledge in the medical field, as well as in the psychology or even social work, defines arbitrarily what it means to be “good enough”, therefore, “resilient”. Wherefore, resilience has being grounded in dominant models
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of human development and centred within “right patterns” linked to dominant culture: Western models, ideology of white people and in the middle class.
Challenging the notion of patterns of resilience Based on that, the behavior expected for young people are also assigned in terms of social expectations. The behavior that falls outside of the “normal”, or what is “socially acceptable”, is associate to a risk behavior and probably labeled as pathologic, and then, not resilient. Bottrell [5) says in her work that “resilience and psychopathology are dichotomized responses to risks to development defined by normative criteria, which minimize the significance of cultural diversity and social positioning”. It makes sense when you listen to marginalized people telling about their own experiences. A study conducted by Fefferman [6] with young boys involved in drug trafficking in favelas at Sao Paulo (Brazil) challenges our notion of resilience. Some of the participants reported during the interviews positive aspects for their development through the engagement in those activities, especially associated with obtaining financial resources, actions of the drug dealers in the communities, and social status gained. Similarly, Davidson and Taylor [7] point out that the classification of the involvement of children and adolescents in the sexual market as "violence, forced labor or slavery, and the emphasis on the inability of children to choose prostitution " limited the discussions to immediacy and impoverished analyses. The authors claim that some adolescents engage themselves to prostitution because the places where they live and grow up do not offer satisfactory opportunities to develop, or when they can not find work or even to escape of forms of violence experienced within their home. Of course we are not defending the involvement of adolescents in the drug trafficking or in the sexual trade. But their speeches are showing us that we are failing in somewhere or somehow as a society which it should be responsible for offering opportunities for their development. When they do not find pathways to resilience in the conventional mechanisms, they need to search it in alternative places. Unfortunately, for some of them, the only possibilitie is through the engagement in anti-social activities. The context of social injustice of many young people at-risk can have drastic effects on them. When we offer services that do not understand their needs, they will refuse our services and some individuals will engage in anti-social activities, because they are looking for validation, a way to recognize themselves, and places and institutions that contribute for the building of their social identity. The lack of meaning in educational programs, as well as the inefficiency of youth services is often replaced by a sense of belonging that was found only by engaging in anti-social activities, and sometimes within groups of people that share similar histories. The meeting with people in the same conditions may be advantageous to create meaningful relationships, even when it requires to take on the stigma of "misfits". Thus, based on Kaplan’s work: “From the subjective point of view, the individual may be manifesting resilience, while from the social point of view the individual may be manifesting vulnerability” [8]. The denial of support and resources for the wellness of young people can lead them to situations that is socially unacceptable, as the cases of sexual exploitation and drug trafficking. Furthermore, it is true that some of these activities in the absence of conventional mechanisms may bring some benefit to the subject, whether in the material conditions, strongly marked by issues of social inequality, or subjective, once the inefficiency of relationships with other people and services lead to unconventional attitudes. This theme can evoke polemical debates, especially regarding to theoretical models grounded on traditionalist mental health approach and human development within a conservative perspective. For us, it is also quite challenging to find plausible justifications to support our arguments. It is not comfortable to recognize that the involvement in illegal or criminal activities can be configured as paths of personal empowerment. But we have to denounce that public policies, including the Federal interventions, as well as academic studies, neglect the understanding of children and young people on their trajectories of involvement in illegal activities [9] [10]. When we start to listen to them, we will find that their personal stories of engagement in crime or illicit activities may differ from the understanding of scientific rhetoric. Armstrong [11]suggests that researches conducted with young people involved in crime are based on statistics correlations which ignore the reality of these groups, since the criminological perspective disregards completely the perspective of young people themselves, as well as other variables that support the annulment of comprehension of risk factors as a social construction. Other studies on the subject, despite being based in different theoretical and methodological propositions, reveal the complexity of the social contexts where young people were inserted in the illicit drug trade [12] [13]. Through all this inhumane process of marginalization and the evident lack of opportunities, some adolescents need to adopt unconventional strategies of personal recognition which can help them to replace unachievable expectations within a system that label them as "youth in trouble". Even when they recognize the implications of dealing drugs, such as the risk of death experienced daily, some of them “choose” to be part of the trade, hoping to improve their lives or at least overcome the miserable conditions experienced before.
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The same arguments can be used to explain some cases involving adolescents and young people in sexual exploitation trade. A study conducted by Rubenson, Hanh, Höjer & Johansson [14] aimed to understand the perspective of Vietnamese adolescents involved in sexual exploitation, emphasizing themes regarding how they live and the strategies to deal with challenges in their lives. The first core discussed by researchers refers to poverty, which implies a precarious repertoire of opportunities for social participation. Unexpectedly, another group presented that sexual activities contribute to make their dreams come true. And only a small group see themselves as victimized, and in these cases the adolescents demonstrated other vulnerabilities (financial debt, oppressive relationships and addict behavior). These findings also dialogue with the surveys conducted in the Brazilian context by Libório [15] [16]. In a society that overestimate the consumption, producing the need to access manufactured products, it is understandable that adolescents and young people desire to be part of this, once they have been highly encouraged to become costumers in the capitalist society. As they are prevented to participate in conventional ways (accumulating capital enough through work), some of them go to alternative strategies. Drug trafficking and sexual exploitation, highly profitable activities for their realities, become attractive for this segment.
Brief considerations The main argument is that anti-social activities, in the absence of conventional mechanisms, may bring some benefit to the subjects [17] [18] [19]. Benefits may be in material conditions, strongly marked by issues of social inequality, or subjective, in gaining relationships with people outside the normative places and institutions for young people. Unconventional circumstances produce unconventional attitudes that are expressed in alternative forms of resilience. Our intention is not to validate the drug trafficking and sexual exploitation of children and adolescents in the contemporaneity. But it is necessary to admit that the social model, marked by inequalities and oppressive realities, lead some young people to alternative ways to build their resilience processes. Thus, we need to eliminate moralist speeches, as well as recognize that the precariousness of resources, inefficiency and lack of social policies, often lead children and adolescents to situations socially undesirable, but these were the only possibilities to generate the sense of wellbeing, belonging and self-esteem, and it supplies something that was not found in settings such as family, school, community, church, and certainly in public policy in general.
References [1]
Bolzan, N., & Gale, F. (2011). Using an interrupted space to explore social resilience with marginalized young people. Qualitative Social Work, 11(5), p. 502-516. [2] Ungar, M. (2004). A constructionist discourse on resilience: Multiple contexts, multiple realities among at-risk children and youth. Youth and Society, 35(3), 341–365, 2004. [3] Ungar, M., Clark S., Kwong, W.M., Camaron, A. & Makhnach, A. (2005). Researching resilience across cultures . Journal of Cultural and Ethnic Social Work, 14(3), 1-20. [4] Ungar, M., Brown, M., Liebenberg, L., Othaman, R., Kwong, W.M., Armstrong , M. & Gilgun, J. (2007). Unique pathways to resilience across cultures. Adolescence, 42(166), 287-310. [5] Bottrell, D. (2009). Understanding ‘Marginal’ perspectives: Towards social theory resilience. Qualitative Social Work, 8, 321-339. [6] Feffermann, M. (2006). Vidas Arriscadas-um estudo sobre jovens inscritos no tráfico de drogas. Petrópoles - Rio de Janeiro: Editora Vozes. [7] Davidson, J. & Taylor, J. S. (2007). Infância, Turismo Sexual e Violência: retórica e realidade. In: LEAL, M. L. P.; LEAL, M. F. P. L.; LIBÓRIO, R. M. C., Tráfico de pessoas e Violência sexual, p. 119–136, Brasília: Universidade de Brasília. [8] Kaplan, H. (1999). ‘Toward an Understanding of Resilience: A Critical Review of Definitions and Models’, In .Glantz and J. Johnson (eds) Resilience and Development.Positive Life Adaptations, pp. 17– 83. New York: Kluwer Academic/Plenum Publishers. p. 31-32. [9] Pells, K. (2009). ‘No-one ever listens to us’: Challenges and obstacles to the participation of children and young people in Rwanda. In B. Percy-Smith & N. Thomas (Eds.), A handbook of children’s participation: Perspectives from theory and practice, 196-203. [10] Pells, K. (2011) ‘Keep going despite everything’: Legacies of genocide for Rwanda’s children and youth. International Journal of Sociology and Social Policy, 31, 594-606. [11] Armstrong, D. (2006). Becoming criminal: the cultural politics of risk. International Journal of Inclusive Education, 10 (2), 265-278.
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[12] [13] [14] [15] [16] [17] [18] [19]
Mclennan, J. D.,Bordin I.,Bennett, K.,Rigato, F. Brinkerhoff, M. (2008). Trafficking among youth in conflict with the law in São Paulo, Brazil. Social Psychiatry and Psychiatric Epidemiology, 43, 816–823. Aguilar, J. P & Jackson, A. K. (2009). From the streets to institutions: female adolescent drug sellers' perceptions of their power. Journal of Women and Social Work, 24(4), 369-381. Rubenson, B., Li Thi, H., Höjer, B., & Johansson, E. (2005).Young sex-workers in Ho Chi Minh City telling their life stories. Childhood, 12, 391-411. Libório, R. M. C. (2003). Desvendando vozes silenciadas: adolescentes em situação de exploração sexual. PhD dissertation (Psicologia Escolar e do Desenvolvimento Humano), Universidade de São Paulo. Libório, R. M. C. (2005). Adolescentes em situação de prostituição: uma análise sobre a exploração sexual comercial na sociedade contemporânea. Psicologia: Reflexão e Crítica, 18(3), 413-420. Ungar, M. (2004).Nurturing hidden resilience: in troubled youth. Toronto: University of Toronto Press. Ungar, M. (2007). Playing at being bad: the hidden resilience of troubled teens. Toronto: Ontario Press. Libório, R. M. C. & Ungar, M. (2010). Hidden Resilience: the social construction of the concept and its implications for professional practices with at-risk adolescents. Psicologia Reflexão e Crítica, 23(3),476484.
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Exposure to adverse childhood experiences and health problems in adulthood: the role of family related protective factors Baban A., Cosma A., Balazsi R. Babes Bolyai University, Cluj Napoca, Romania
[email protected]
Abstract The exposure to adverse experiences (ACEs) during the first 18 years of life can have long negative term effects on people’s mental and somatic health. ACEs include verbal, physical, or sexual abuse, as well as family dysfunction (e.g., an incarcerated, mentally ill, or substance-abusing family member; domestic violence; divorce or parental separation). Using a CDC-WHO methodology (the Adverse Childhood Experiences Study), the present study aims to investigate the relationship between ACE and mental and somatic health problems in young adults. Secondly, we investigated the role of family related protective factors (e.g. there was someone in your family to take care of you, to make you feel important or loved) in the relationship between the exposure to adverse childhood experiences and health problems. Our sample consisted from 2088 Romanian university students. The results indicate that as the exposure to ACEs categories increases, the odds for experiencing mental health and somatic health problems also increase. The presence of positive related family factors did not change the association between exposure to ACE and health outcomes. Several recommendations for future research are presented. Keywords: adverse childhood experiences, mental health problems, somatic health problems, family protective factors.
Introduction During their development, in their first 18 years of life, children can be exposed to an increased number of adverse experiences and situations. These experiences vary from child abuse and maltreatment (physical and psychological abuse and/or neglect) to a large number of family dysfunctional situations (mother’s abuse; alcohol, illicit drug consumption by one of the family members; mental illness of one of the family members) [1]. Researchers, practitioners, educators, policy makers, NGOs, and other community members offer a constant attention towards this issue [2].
1.1
Exposure to adverse experiences during childhood
Being exposed to abuse and neglect throughout childhood can have for a person immediate and long term negative consequences [3, 4]. Using a retrospective research methodology, a number of studies (ACE studies) had investigated the prevalence of exposure to adverse childhood experiences (ACE) and its relationship with health outcomes in adulthood [3, 5, 6, 7]. A consistent number of studies indicated that certain abuse categories (physical abuse and neglect, psychological abuse and neglect, sexual abuse) co-occur throughout childhood with several categories of family and household dysfunctions (from domestic violence and substance abuse by a family member, to criminal behavior or mental illness of a family member). These categories have been labeled ACE categories in the studies which adopted the same methodology. According to these studies, as the child is exposed to a higher number of ACE categories, risk for developing health problems such as: chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), or liver disease increases also [3]. Moreover, experiencing adversity during childhood has been linked to a higher risk for developing mental health problems in adulthood, such as: depression [7], suicidal ideations and suicidal attempts [5]. According to a WHO international report, in a Romanian university sample, the exposure to adverse experience during childhood has high prevalence among young adults. Specifically, the most prevalent ACE categories to which the participants were exposed are: physical abuse (26.9%); psychological neglect (26.3%); psychological abuse (23.6%); alcohol misuse by a family member/FM (21.6%); mother treated violently (16.5%) and physical neglect (16.5%). Female participants were exposed more often to psychological neglect, sexual
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abuse, alcohol misuse by family member, mental illness of one family member, and domestic violence; on the other hand, male participants experienced more often physical abuse and physical neglect [9]. Similarly, other studies which have used other research methodologies evidence that an increased exposure to childhood adversity has a corresponding increased levels of conduct/antisocial personality disorder, violent and property crimes, alcohol and drug dependence. Moreover, the exposure to a higher number of adversities (more than 6) during childhood increased the risks for externalizing and internalizing problems later in adolescence and young adulthood [10]. Despite all the evidence previously presented, the relationship between exposure to adverse experiences during childhood and negative outcomes later on in life it is not a deterministic one. There are plenty of evidence which indicate that even children who had lived in extremely adverse conditions had not develop adjustment and health problems later on in life [11, 12].
1.2
Resilience and child maltreatment
Resilience is viewed as the dynamic developmental process which facilitates the attainment of positive adaptation within the context of significant adversity [13]. The two main critical conditions required to conceptualize resilient development as exposure to severe adversity, threat or trauma and the manifestation of positive adaptation despite experiencing those adversities [13, 14]. Experiencing abuse and neglect while growing up can have a negative impact upon the physical, social, psychological development. Nonetheless, not all individuals who experienced those negative life situations end up by having an impaired development. Cicchetti and Rogosch [15] identified that ego-control and ego-resilience (as personality characteristics), and positive self-esteem act as factors which foster resilient development in disadvantaged maltreated children. In addition, the use of functional emotional regulation strategies has been identified as predictors for resilience. The same authors indicated that EEG asymmetry and cortisol levels are related with resilience in maltreated children (physically abused children with higher levels of morning cortisol displayed higher resilient functioning) [14, 15]. Moreover, resilient functioning for abused children has been associated with the availability of emotional support at the time of the abuse [16] and with the ability to form, maintain and benefit from good inter-personal relationships [17]. The extent of recalled parental care and support, and the quality of adolescent peer relationships have been reported to be protective factors in a longitudinal study for children exposed to child abuse [18]. The present study has two main objectives. First, we investigate the relationship between exposure to adverse childhood experiences and health problems in young adults; secondly, we assessed the role of family related protective factors in the relationship between the exposure to adverse childhood experiences and health problems.
Methodology 1.3
Participants
In the present study were included 2088 participants (64.3% were female and 35.7% were male). We selected a representative sample for Romanian university students. The mean age of respondents was 24.51 years old (SD=± 7.09).
1.4
Instruments
The Adverse Childhood Experiences (ACE) questionnaires were used for this study. These questionnaires were developed by the Center for Disease Control and Prevention (Atlanta) in 1997, (www.cdc.gov/nccdphp/ace) and include Family Health Questionnaire and Physical Health Appraisal Questionnaire, both with separate versions for men and women. For the purpose of this study, the following dimensions were included: exposure to adverse childhood experiences, family protective factors, mental and somatic health problems.
1.4.1 Exposure to Adverse Childhood Experiences Exposure to child maltreatment (physical abuse and neglect, psychological abuse and neglect, sexual abuse) and household dysfunctions (alcohol abuse, mental illness in the family, mother treated violently, parental divorce, family member incarcerated) was measured. A composite score (ACE score) was computed to form an indicator of exposure to adverse childhood experiences by adding individual items score, the score ranging from 0 up to 11 (0 means that the absence of any of adverse experience) (3, 7).
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1.4.2 Positive Family Related Context Positive family related context (PFRC) was measured using 7 items: there was someone in your family: who took care of you; took you to the doctor; who loved you; who helped you feel important; your family members felt close to each other, your family members took care one of other; your family was a source of strength and support. In order to verify the single-dimensionality of the scale, we used a confirmatory factorial analysis, and the computed fit indices supported the existence of a single factor. A composite score was computed by summing the score to each of the seven items, the score ranged from 5 to 35.
1.4.3 Mental and Somatic Health problems Mental health problems score was generated by adding the score of two items: “have you had depression” and “have you had sleep problems”. Somatic health problems score was computed by adding the score of the following items: constipation, high blood pressure, back pains, headaches, and problems with urinary tract.
1.5
Data analysis
For the purposes of the study we used univariate and bivariate descriptive statistics. In order to verify the hypothesis of our study, we tested a path analysis model. All the statistical procedures and analysis were done by using SPSS-IBM 20.
Results About one third of the participants (35.5%) haven’t been exposed to any ACE category. More than 64% of participants have been exposed to at least one ACE category (64.4% of males and 65.5% of females). One ACE category was experienced by 25.9% of females and 19.8% of males. The experience of any two categories of ACEs occurring together was common for 25.9% of males and 19.8% of females. Any three categories of ACEs were experienced by 9.3% of males and 9.5% of females. Four or more ACEs categories were experienced by 15.2% of males and 20.1% of females. The odds of having most of these health problems were higher as the number of ACEs increased. The odd ratio for having depression was 1.9 times more likely as the person was exposed to one ACE category, and it increased to 6.33 times as the number of ACEs reached four and more (OR=6.33, 95% CI=6.64-8.65). The chance of having sleep problems was 1.62 more likely (OR=1.62, 95% CI=1.25-2.11) when the person was exposed to one ACE category, and it increased to 3.32 times more likely if the person was experienced four or more ACE categories (OR=3.32, 95% CI=2.53-4.35). In the case of somatic health problems, the chance of experiencing constipation was 1.46 (OR=1.46, 95% CI=1.08-1.97) more likely if the person was exposed to one ACE category, and the chance increased to 1.65 (OR=1.65, 95% CI=1.22-2.24) as the person was exposed to four or more ACE categories. The chance of experiencing back pains was 1.52 (OR=1.52, 95% CI=1.18-2.09) more likely if the person was exposed to one ACE category, and the chance increased to 2 (OR=2, 95% CI=1.54-2.62) as the person was exposed to four or more ACE categories. Experiencing headaches was 1.41 more likely (OR=1.41, 95% CI=1.08-1.85) if the person was exposed to one ACE category, and it increased to 1.82 (OR=1.82, 95% CI=1.38-2.4). Reporting having problems with urinary tract was 1.86 more likely (OR=1.86, 95% CI=1.22-2.83) for the persons exposed to one ACE category, and the likelihood increased to 2.55 (OR=2.55, 95% CI=1.77-3.7) when the person was exposed to four or more ACE categories.
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ACE
Mental Health
FRPF Somatic Health ACExFRPC Fig. 1. Proposed Path Model
In order to verify our hypothesis, we specified a path analytic model using ACE, PFRC and ACExPFRC as exogenous variable (predictors) and mental and somatic health as endogenous variable (criteria). The resulted model was just identified as a consequence no global model fit was computed. Path indicators are presented in Table 1 (unstandardized coefficients). Table 1 Path indicators for the proposed model
Estimate Mental Health .05). Since possible differences could be found within adoptees who have experienced a higher amount of pre-adoptive distress, risk variables (institution, number of changes, age and level of attachment disturbances at placement) were recoded into dichotomous variables, considering their distribution within the sample (half subjects in the higher range and the other half in the lower range). By comparing them through the Mann-Whitney Exact test, a unique significant result emerged: adoptees who differed with respect to the DAI scores (high versus low presence of disturbances at placement), showed significantly different internalizing problems (see Table 6). Adoptees who scored higher on attachment disturbances, during adolescence manifest a higher level of internalizing problems, even when controlling for gender. Table 6 Maternal-reported behavioral problems with respect to high/low DAI scores
Lower score Higher scores Total (*)
N. 9 10 19
Internalizing * M (DS) 6,67 (5.39) 14,60 (8,67) 10,84 (8,19)
Externalizing M (DS) 5,44 (4,82) 10,20 (11.35) 11,35 (8,94)
Mann-Whitney Exact Test, Monte Carlo Method, p < .05 (Two tails)
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Total M (DS) 20,11 (17,21) 39,60 (25,90) 30,37 (23,81)
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On the contrary, having lived in an institution, having experienced multiple changes in caregiving, and having been adopted later does not influence, in our sample, the rate of behavioral problems in adolescence.
1.3
Parental competence and experience
Concerning the relationships between parental competence and experience, and adolescent’s adjustment (see Table 7), we found a systematic effect of externalizing problems (both self- and maternal-reported) on negativity of child perception and parental experience. Table 7 Parental caregiving representation and adolescent’s adjustment
Mother PDI Scales Parental capacity
Intern. -,14
Positive parental experience
,01
Negative parental experience
-,17
Child’s positive description
-,20
Child’s negative description
-,30
YSR (N=25) Extern. -,19
Mother’s CBCL (N=24) Total -,25
Intern. -.11
Total -.11
- .22
Extern. -.07 - .42 *
-,36 ,50*
-,26 ,24
. 02
. 23
. 19
-,25 ,56**
-,34
- .10 -.07
- .31 .47*
- .19
,19
- .35
.23
Contrarily to our hypothesis, higher scores on parental capacity do not correspond to lower behavioral problems among adoptees. Parental experience is negatively associated with externalizing problems, and positively associated with child’s negative description, meaning that adoptees who show higher externalizing problems have mothers who describe their parenthood experience as more negative and their child as more aggressive and controlling.
Discussion and conclusions Our results are preliminary and descriptive, and our sample size is still limited. Nevertheless, we can highlight the absence of relationships between early risk factors and adjustment in adolescence. Indeed, contrarily to our preliminary hypotheses, the level of pre-adoption risk was not associated with the behavioral adjustment in adolescence in our sample. Only the high rate of attachment disturbances at placements seems to be correlated with a higher level of internalizing problems during adolescence. Since just a few studies analyzed the effect of pre-adoptive risks among adolescents, this unexpected result could be link to the reparatory value of having lived several years (on average 10) within the adoptive family. The daily and continuous experience in a good familiar environment could limit or even help canceling the role of negative experiences underlined by the adoption literature [7]. Nevertheless, this effect could be enhanced by a selection bias: even if we cannot control for the number of request sent by adoption agencies and services, we know that just a small percentage of families accepted to take part in our study, and these families could be the better adjusted. Concerning the caregiving characteristics, our results are less encouraging: apparently, parental competence is not influencing adolescent adjustment, and in our sample only the relationships between difficult experiences (i.e. present and manifest, such as adolescents’ externalizing problems) are evident. Deeper analyses will help better differentiate maternal and paternal role, individual profiles, and the interrelation between different risk and protective factors. For instance, analyzing in a longitudinal perspective each individual path will allow a deeper understanding of the time spent in the adoptive family.
References [1] [2] [3] [4]
Zeanah, C., Egger, H., Smyke, A., Nelson, C., Fox, N., & Marshall, P. (2009). Institutional Rearing and Psychiatric Disorders in Romanian Preschool Children. American Journal of Psychiatry, 166(7), 777–785. Gunnar, M., van Dulmen, M., & the International Adotion Project Team. (2007). Behavior problems in postinstitutionalized internationally adopted children. Development and Psychopathology, 19(1), 129–148. Judge, S. (2003). Developmental recovery and deficit in children adopted from Eastern European orphanages. Child Psychiatry & Human Development, 34(1), 49–62. Verhulst, F. C., Althaus, M., & Versluis-den Bieman, H. J. (1990). Problem behavior in international adoptees: I. An epidemiological study. Journal of the American Academy of Child & Adolescent Psychiatry, 29(1), 94–103.
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[5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]
Erich, S., Kanenberg, H., Case, K., Allen, T., & Bogdanos, T. (2009). An empirical analysis of factors affecting adolescent attachment in adoptive families with homosexual and straight parents. Children and Youth Services Review, 31(3), 398–404. Schechter, M. D., & Brodzinsky, D. M. (1990). The psychology of adoption. New York : Oxford University Press, 167 – 186 . New York: Oxford University Press. Schofield, G., & Beek, M. (2006). Attachment Handbook for Foster Care and Adoption. London: BAAF. Howe, D. (2006). Introduction. In G. Schofield & M. Beek (Eds.), Attachment Handbook for Foster Care and Adoption. London: BAAF. Bimmel, N., Juffer, F., van, Ij. M. H., & Bakermans-Kranenburg, M. J. (2003). Problem behavior of internationally adopted adolescents: a review and meta-analysis. Harvard Review of Psychiatry, 11(2), 64– 77. Juffer, F., & van Ijzendoorn, M. H. (2005). Behavior problems and mental health referrals of international adoptees: a meta-analysis. JAMA, 293(20), 2501–2515. [11] Pierrehumbert, B. Attachment & Adoption Research Network (2009). Retrieved from http://aarnetwork.wordpress.com/ . Smyke. A., & Zeanah, C. (1999). Disturbances of Attachment Interview. Section of Child andAdolescent Psychiatry - Tulane Univeristy School of Medicine. Achenbach, T., & Rescorla, L. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington, VT: University of Vermont , Research Center for Children, Youth, & Families. . Aber, J., Slade, A., Berger, B., Bresgi, I., & Kaplan, M. (1985). The Parent Development Interview. Roskam, I., & Al., E. (in preparation). Cross-informant ratings of internalizing and externalizing behavior in adolescent-parent pairs Does being adopted make a difference? .
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The resilience of adopted children in Romania Muntean A.1, Ungureanu R.2, Tomita M.1 1
Social Work Department, West University of Timisoara, Romania Research Centre for Child Parent Interaction (CICOP), West University of Timisoara, Romania
[email protected];
[email protected];
[email protected] 2
Abstract In his famous ERA (English Romanian Adoptions) study Michael Rutter and his team found a percent of about 25% of children adopted from Romania, from very bad conditions in institutions, as being resilient. Following this observations the concept of resilience was extended to include the genetic heritage as well as the cultural framework. Our study is based on the evaluation of 56 adoptees within Romanian adoptive families. The evaluation of adopted children and adoptive families was done within a national research project on domestic adoption, FISAN (Factors which supports the success of adoption), funded by the Minister of Education in Romania, between 2008-2011. The resilience is considerate within our study as being the equivalent of child’s secure attachment toward his/her parent or another significant person. The complex procedure of evaluation as well as the statistic work on the data will highlight the important emotional and social factors which support the resilience of the adopted children. Keywords: resilience, adoption, adolescents, identification
Introduction Within human development, the resilience is a fascinating topic. When adverse existential conditions expose at risk the development of the person, the resiliency is pushing a new bounce back and even is bringing new quality in development. The concept was developed in relation with ‘invulnerable’ and ‘invincible’ children thriving despite the scarce conditions for their life. In a classic longitudinal study [1] followed 505 individuals, from their birth, until their 40s, in the Island of Kauai, Hawaii. Despite the poverty and associated adversities faced during their life, a third of them developed in a healthy, resilient way. [2] talks about having personal capacities which can contribute to resilient outcomes following stressful conditions as well as about resilience which is a ‘dynamic’ process in place only in relation to adverse conditions. Based on the large existing literature, the authors mentioned “two critical conditions: (1) exposure to significant threat or severe adversity; and (2) the achievement of positive adaptation despite major assaults on the developmental process.”[2]. Due to this definition to talk about the resilience of adopted children is just compulsory. The adoption of an abandoned child brings to the child traumatized by abandonment as well as by possible events before and following the abandonment a new chance for re-bounding. Adoption as a new chance is tightly connected with the resilience process of the adopted child. During the last years more and more professionals and researchers talked about interventions aimed to stimulate the resilience [3]. Even there are not yet very many voices to claim the resilience of the child as the goal of the adoption, the resilience of the child should be a pervasive objective of the child protection system in any country. Michael Rutter [4] and his team highlighted the resilience of Romanian children adopted in UK. His study is probably one of the most known in the literature focused on child’s adoption. Following the Romanian children adopted from terrible traumatizing environment in institutions in Romania, 25% of those children, placed in adoptive families in UK, managed very well and found their way for a healthy development. They were resilient despite all the traumatic past conditions in their life.
The theoretic framework of our research Our study is based on the evaluation of 56 adoptees within Romanian adoptive families. The evaluation of adopted children and adoptive families was done within a national research project on domestic adoption, FISAN (Factors which supports the success of adoption), funded by the Minister of Education in Romania, between 2008-2011.
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We intend to explore here the resilience of 12 Romanian adopted children, aged 11-16. Despite the traumatizing early life these children could develop a secure attachment toward their adoptive parents. The secure attachment is the guarantee for mental health and for pervasive healthy development [5]. We do not identify the secure attachment with the resilience but we consider the secure attachment as being the sign of the child’s resilience as well as assurance for further life’s adversities. More than that, taking in account the cascade theory [6] we consider the secure attachment as a barrier of the aversive events cascade in the life of children who started their life unfortunately through a traumatic event: the abandonment.
Procedure The 12 adopted teens were assessed and identified as having clearly secure attachment. The evaluation was done with Friends and Family Interview/FFI [7]. FFI is a semi structured interview assessing attachment representations in late childhood and adolescence. “The FFI holds significant research and clinical value in its unique approach to eliciting and systematically rating autobiographical narratives from an age group that has been notoriously difficult to assess from an attachment perspective.”[8]. From the scientific point of view, a cross-country comparison on the invariance of FFI, focusing on the coherence in attachment narratives confirmed the validity of the coherence assessment with no difference between Romania and Belgium [9]. In our qualitative investigation we will try to identify within the narratives of the 12 adopted teens the aspects which reveal their resilience. Following the analysis done by [10] on the concept of resilience we will pick up for our investigations the common protective factors which she selected based on the work of [11], [12], [13], [14], [15], and [1]. These are: (1)
Positive relationship, (2) sense of personal worthiness, (3) believes in her or his self efficacy, (4) sense of humor and (5) high expectations.
In order to find the items above within the attachment narratives of the 12 adopted adolescents we focused on the following questions in FFI: 1. 2. 3. 4. 5.
Who are the persons you are close to? Tell me how you are? What do you like about yourself? How are you at school? Did you have recent examinations? What are your three best desires for your future?
Beside these items we take in considerations some common aspects within the narratives of these securely attached adopted children. We are working on our data using the qualitative discourse analysis method focused on the narratives of the respondents and based on the 5 relevant items mentioned above.
Results In respect to ‘positive relationship’ all these children in the sample here are securely attached. This means that they have at least one exceptional positive and healthy relationship with him or her attachment figure. We further investigated their positive relationship through the question: Who are the persons you are close to? The 12 adolescents mentioned first the mother but half of them mentioned also the father and the friends. Grandparents and siblings are also mentioned (3 times, grandparents; 2 times, sibling). The “sense of personal worthiness” was mostly investigated through the question: Tell me how you are? or What do you like about you ? The respondents mentioned very different aspects considered as personal worthiness: the courage, the talent to learn new languages, the pleasure to learn mathematics, the interest for learning, the way of thinking and even “I like the way I look”. There are two answers more elaborated: 1. 2.
I like my way of thinking which is a bit different comparing with my classmates… I am not interested on the things which are common interest among peers… My qualities are connected. Being creative I need social relations. I cannot be creative without others. For instance I like to write and I write about people. What I like the best on me is my altruism.
All 12 adolescents “believe in her or his self efficacy”. The questions used to explore the self efficacy were: How are you at school? Did you have recent examinations? or even Tell me about you? All the respondents mentioned the good results in the school, insisting on different disciplines according with their interest. Two answers are relevant in this respect:
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1. 2.
Excepting the 5th form I was always the best in my class…yes, we had some examinations and I had good results and some of my classmates were jealous on me…but I ignore them and doesn’t matter what they say I follow my dreams..and do what I want to do… I can be shay sometimes…But I like to make acquaintance with new friends and I like to fight. If I have some problems or something I cannot do it I will work on that till I become good…
The sense of humor is quite common within the sample of adolescents. As an answer to the question: Tell me how you are…, out of 12 respondents, 8 are explicitly mentioning:”I like to laugh…” Mostly this assertion is followed by the mentions of different significant persons within the child social environment: mom, the father or friends. The high expectations item is explored through the question: What are yours three best desires for your future? The answers have a large variety but all of them have the power to orientate the future development of the respondents. The 12 adolescents mentioned within their narratives the wish to continue attending the school despite the fact that to this precise question only 8 respondents were explicitly mentioning the school. The dreams of the children in our sample are always positives even they are more or less realistic. We give here two answers: when answer is formulated at general level; 1. To be always beloved, to have what I need...I do not talk here about money…never to feel alone. The other one is more realistic in its expectations: 2. To study and to become doctor. To have my job and to manage by myself and not to overload my mom…to have a dog.
Discussions Being a qualitative research the size of our sample is very convenient. The items found globally within the literature on resilience gave us a simple tool to work on the data. This is a superficial and easy way to demonstrate an idea which is common: the secure attached children are resilient. But the question raised through our analysis is connected with the stability of attachment quality and the dynamic of resilience. According with our results we can expect that these adolescents will show always as being resilient persons; they proved once their resilience when being abandoned and placed in institutions after words, before being adopted, and being successful within their new family in setting-up a secure attachment. The literature on resilience stresses the variety of manifestations and the dynamic of resilience [2]. The person can be resilient in one situation but the same person will behave differently exposed to a new stressful situation; on the other hand, being resilient in one domain does not mean an overall resilience in any other existential field. This common idea within the literature on resilient is somehow in opposition to the theory of developmental cascades: “…effectiveness in one domain of competence in one period of life becomes the scaffold on which later competence in newly emerging domains develop: in other words, competence begets competence.” [6]. We consider the respondents who are securely attached as being resilient. This is hazardous as the resilience can be proved only within the analyses of the past events. It would be better to say just that they are better equipped for behaving resiliently when confronting life’s adversities.
Conclusions Within the little sample here of securely attached children we found all the most common items mentioned as being the protective factors in case of resilience. This conclusion stress one of the aspects always mentioned within the literature on resilience: the importance to benefit of the support of a trustful significant person. Having secure attachment means having attachment figure ready to protect, to calm down the anxieties and to support. An adolescent in our sample, stated the relationship between secure attachment and resilience in the best way. She answered the question regarding the temporary separation from her parents by saying: “when I was separated it was like walking on a stream and I can fall down any time…but when they are there I know there is a support under me and I cannot fall down.” Especially due to their age, when the developmental task is to build-up the self-identity, the dreams on the future are like a powerful drives for these adolescents. On other aspect which is not investigated within our study, through the instrument which we used, but just came up during the narratives of the children is the way in which they are equipped to ask for support when they need. All of them mentioned resource persons in such situations. Mostly of them mentioned mom but also friends or other relatives. The healing process post trauma include the capacity to ask for support and not to deal alone with adversities, feeling abandoned by other people.
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We also have to mention another particular aspect: all these securely attached and resilient children have some talents or practice arts or sports. We consider that this way to express them self is for highest importance for the resilience of the adolescents. Arts and sports impose rules and limits which also contribute to self-development and self-education. As we found in the research done on students, the capacity to push them self to overpass the comfortable limits in doing some tasks is a common item for the resilience. It is like resilience is asking for self-organization and capacity to rise and keep standards for you. The last aspect which we found and we have to mention here is the importance of pets for these securely attached and resilient children. The particular aspects mentioned above which can be involved in the process of building up the secure attachment as well as the resilience needs and deserve further explorations.
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]
Werner, E., Smith, R. (1982).Vulnerable but invincible: A study of resilient children. McGraw-Hill; New York. Luthar, S. S., Cicchetti, D., Becker, B. (2000). The Construct of resilience: A Critical Evaluation and Guidlines for Future Work, Child Development, 71 (3):543-562. Ionescu, S. (coord.) (2011). Traité de résilience assisté, Ed. PUF/Quadrige, Paris. Rutter, M. and Sonuga-Barke, E. J. (2010). X. CONCLUSIONS: OVERVIEW OF FINDINGS FROM THE ERA STUDY, INFERENCES, AND RESEARCH IMPLICATIONS. Monographs of the Society for Research in Child Development, 75: 212–229. doi: 10.1111/j.1540-5834.2010.00557.x. Schore, A.N. (2001, a). Clinical implications of a psychoneurobiological model of projective identification. In S. Alhanati (Ed.), Primitive mental states, Vol. lll: Pre- and peri-natal influences on personality development. New York: Karnac. Masten, A., Cicchetti, D. (2010). Editorial: Developmental cascades. Development and Psychopathology, 22: 491-495. Steele, H. & Steele, M. (2009), Friends and Family Interview, Center for Attachment Research, New School for Social Research. Kriss, A., Steele, H., Steele, M. (2012). Measuring Attachment &Reflective Functioning in Early Adolescence: An Introduction to the Friends and Family Interview. Research in Psychotherapy: Psychopathology, Process and Outcome, vol15, no.2.,pp.87-95 [9] Stievenart, M., Casonato, M., Muntean, A., Van de Schoot, R. (2012). The Friends and Family Interview: Measurement invarince across Belgium and Romania, European Journal of Developmental Psychology, DOI: 10.1080/17405629.2012.689822. Earvolino-Ramirez, M.(2007), Resilience: A concept Analysis, Nursing Forum, vol.42 (2):73-82 Anthony, E.J. (1974). Introduction: The syndrome of the psychologically vulnerable child. In: E.J. Anthony,C. Koupernik, (eds). The child in his family: Children at Psychiatric Risk. Vol. 3. Wiley; New York, pp. 3–10. Bernard, B. (1991). Fostering Resiliency in Kids: Protective Factors in the Family, School, and Community. Portland, Ore.: Northwest Regional Educational Laboratory. Garmezy, N. (1991). Resilience in children's adaptation to negative life events and stressed environments. Pediatrics. 20:459–466. Masten, A.S. (1994). Resilience in individual development: Successful adaptation despite risk and adversity. In:M.C. Wang, E.W. Gordon, (eds). Educational resilience in inner-city America: Challenges and prospects. Erlbaum; Hillsdale, NJ, pp. 3–25. Rutter, M. (1993). Resilience: Some conceptual considerations. Journal of Adolescent Health. Vol. 14, pp. 626–631.
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Mother’s image of her adopted child and peculiarities of attachment relationships in adoptive family Sabelnikova N.1, Kashirsky D.2 1
Altai State Pedagogical Academy (RUSSIA) Altai Academy of Economics and Law (RUSSIA)
[email protected],
[email protected] 2
Abstract The aim of the present study was to examine peculiarities of mother’s image of adopted child and its role in emotional parent-child relationships. The sample consisted of 36 adopted children, their 32 adoptive parents and 35 nonadopted children living with their biological parents and their 35 parents and 20 children from orphanages. Parents were administered Semantic Differential by Osgood revealing the peculiarities of mother’s image of ideal child and their adopted child, Unfinished Sentences by Yaparova, Patrent Attitude Questionnaire by by Varga and Stolin and Family Drawing. Children were assessed with Kerns’ Attachment Scale, WHOTO scales by Friedlmeier and Family Drawing. The data were subjected to qualitative and quantitative analysis. The results revealed peculiarities of biological and adoptive mothers’ images of their adopted children and their attitude to the child. There was a significant association between children's security of attachment and adoptive mothers’ attitude to the child, between child’s peculiarities of mother’s image of her adopted child and child-parent attachment relationships. The implications of the study for the practice of psychological help for adoptive families are discussed. Keywords: child-parent attachment, adoptive families.
Introduction Raising a child in a family environment, in any of its variants, is the most suitable to his or her mental, social and emotional development [1], [2], [3]. In the last 10 years in Russia the number of children being adopted has increased. Many children in Russia are late adopted (placed to the family at age 3-8 years and later). Late adopted children usually have difficulties in building relationships with adoptive parents due to their unfortunate experience of attachment to caregivers in the past. Growing body of research has emerged with respect to adjustment of adopted children and the factors underlining their adjustment. Very often the quality of attachment to adoptive parents serves as an indicator of child’s adjustment. There is evidence that the attitude of the adopted child to the family and his adoptive parents as to a source of support and the development of secure attachment relationships between family members can be considered as one of the most important features of effective adaptation of the adopted child to the family [4]. Different factors implicate the development of secure attachments in adoptive families. Our research is aimed at the study of the condidions of the development of secure attachments in adoptive families and examining peculiarities of mother’s image of adopted child and its role in emotional parent-child relationships in particular.
Method 1.1
Subjects
The sample consisted of 36 late adopted children aged 6 - 9, living in adoptive families more than 2 years, and their 32 adoptive parents residing in Barnaul, Slavgorod, Zarinsk and rural areas of the Altai Territory (Russia) and 35 nonadopted children of the same age living with their biological parents and their 35 parents and 20 children from orphanages.
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1.2
Measures and procedure
Parents were administered Semantic Differential by Osgood revealing the peculiarities of mother’s image of ideal child and their adopted child, Unfinished Sentences by Yaparova, Parent Attitude Questionnaire by Varga and Stolin and Family Drawing. Children were assessed with Kerns Attachment Scale, WHOTO scales by Friedlmeier and Family Drawing. For Family Drawings analysis we employed Fury attachment coding system.
Results 1.3
Adopted children’s attachment to their adoptive mothers
1.3.1 Attachment figures of adopted children In the majority of cases adopted children named adoptive mothers, peers, mainly siblings and friends as attachment figures. Most of children (91%) placed adoptive mother on top of the attachment figures hierarchy. Comparing foster children with children of biological families and orphanages, we found that in general they more commonly called adults (t=2.12, p≤.05) as objects of attachment, indicating the experience of their relationships with adults as more significant than for their peers from other social situation of development. Another feature of the adopted children - unlike the children raised in biological families they less often mentioned parents for proximity-seeking function less often, they more often prefered to cope with their negative emotions alone.
1.3.2 Security of attachment The results obtained with Kerns’ Attachment Scale showed that 57.2% of adopted children had insecure attachment to the mother and 42.8% - moderately secure attachment, highly secure attachment was not noted in any of the adopted child. Comparing these data with the attachment security of children from biological families, where children had no experience of long-term separation from close adults, we found out that they were more securely attached to their parents than adopted children to their adoptive mothers (U=70, Z=2.43, p≤.014). Drawings show the absence of signs of emotional disturbance in 31% cases. In the drawings of 29 % children there were the signs of avoidant attachment, 11% - of anxious-ambivalent and 11% - of disorganized attachment.
1.4
Mothers’ attitude to an adopted child and representations of him
1.4.1
Mothers’ attitude to an adopted child and his security of attachment
According to the data earned from “Unfinished Sentences” 78% of parents have a positive attitude towards their adopted child, 15% - neutral attitude, 7% - negative. The vast majority (78%) of adoptive parents have positively colored image of their families and praised it in comparison with other families. Describing their children they used epithets "prosperous", "happy", "great", "best", "very successful", "right", "friendly". 22% of parents rating their families had difficulty, they could not finish the sentence, "In comparison with most other families ...". In the statements relating to the image of the child, the positive emotional attitude to the child was shown by the majority of adoptive parents (52%). They considered the child as a joyous event in their life, “happiness”, 10% - as the “responsibility”, and only a quarter of parents - focuses on a child as an "independent person, who needs attention and understanding” . We should note that adopted children of the last group of parents showed the highest security of attachment. This fact allows us to conclude that attention to the child’s needs and motivations, associated with care and sensitivity of the parent, contributes to the establishment of secure attachment relationships within adoptive families. 78% of adoptive parents who participated in the study, described the nature of their relationship with the child as a warm, close, friendly. Almost all of them emphasize the importance of trust in the relationship with the child. The greatest variety of responses we got in saying "The most important motherhood / fatherhood for me ...". They consider most important for them responsibility, love, happiness, fulfillment of duty, etc. The results of the analysis of adoptive family drawings showed that 47.2% of mothers had a positive image of their adopted child and that they experienced positive emotions associated with relationships in the family, other mothers’ figures had signs of emotional distress related to the family situation. 29% of adoptive mothers did not feel close to their adopted children. For example, four mothers symbolically excluded themselves or their children from the family situation, one mother separated children from parents by symbolic barriers, one of the drawings illustrated a situation punishing of children for disobedience.
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The analysis of the "Parent Attitude Questionnaire" responses of adoptive and biological mothers revealed the following differences between the groups. Adoptive mothers experiencing difficulties with the general emotional acceptance of their adopted children. They scored lower on the scale of "acceptance" than mothers who were raising their biological children (U=95, Z=1.57, p≤.10). There was no significant difference between mothers of two groups in their scores on the scales "cooperation", "symbiosis", "control" and attitude toward the child as to a “little loser". So, one can see that adoptive mothers seek to establish cooperative relationships with the child, but cannot accept him as he is - with his interests, feelings, thoughts. Then we analyzed correlation between children’s security of attachment and mothers’ attitude to them in biological and adoptive families. It appeared that authoritarity and attitude toward the child as to a "little loser” in adoptive families were related to the security of attachment to the mother (r=-.54, p≤.05 and r=-.56, p≤.05 respectively). In biological families the security of child’s attachment to mother correlated only with the child as a "little loser" (r=-.48, p≤.05).
1.4.2 Mothers’ representations of an adopted child and his security of attachment The analysis of representations of adopted child and ideal child showed similarities of these images in the following characteristics “charm”, “volubility”,”compliance”.Student's t-test for dependent samples allowed us to establish differences in mothers’ characteristics of real child and ideal child, united in factors «evaluation» (t=2.96, p≤.01) and «strength» (t=3.86, p≤.001). Mothers would like their adoptive children to be more conscientious (t=2.82, p≤.05), honest (t=4.06, p≤0.001), strong (t=2.43, p≤.05), independent (t=3.88, p≤.001), self-confident (t=4.01, p≤.001), self-sustained (t=3.39, p≤.01) than they really are. Comparison of adoptive and biological parents’s images of the child showed that the image of the ideal child of biological parents comparing with the same of adoptive parents is stronger (t=2.59, p≤.05) and more honest and less stubborn. Biological mothers value their children as more etermined (t=3.55, p≤.001), good (t=2.71, p≤.01), independent (t=2.88, p≤.01), more sociable and less irritable (t=6.07, p≤.001) comparing with adoptive mothers. Using correlation analysis, we found an association between adoptive mother’s image of her child and security of his attachment to her. Positivity of the mother’s image of adopted child correlated with the security of child’s attachment (r=.41, p≤.05). The extent of differentiation of mother’s image of her adopted child was also correlated with the security of his attachment (r=.32, p≤.05).
Conclusion Being adopted a child meets new parents who take an important place in his hierarchy of attachment figures. High significance of the relationships with new parents affects the peculiarities of this hierarchy. They put adoptive mothers at the top of the hierarchy more often than peers from non adoptive parents and children from foster homes. They prefer parents for safe haven and for secure base functions, but this doesn’t concern proximity seeking. Having prior experience of dysfunctional relationships with close adults they feel more alienated from their adoptive parents than children living with biological parents. The results support an association of peculiarities of adoptive mother’s representations of adopted child and attachment relationships in adoptive families. The study revealed differences between adoptive and biological families in regard to the association between children’s quality of attachment to mother and her parental attitude to him. The majority of parents has positive representations of adopted child and are satisfied with family relationships but not all of them experience emotional closeness with them. The results show that mother’s positive emotional attitude to the child and to the family, differentiated image of her adopted child, being reflective to the child’s needs and motivations are associated with secure attachment to the mother of the adopted child. Limitations of the study are due to a small sample size and the peculiarities of the group of adoptive families. Adoptive families taking part in our research represent a small proportion of adoptive families, only those who visit the psychological centers for such kind of families.
References [1] [2] [3] [4]
Dubrovina, I.V. (1990). Psychological development of foster care children. Moscow: Pedagogika. Karabanova, O. A. (2004). Psychology of family relationships and basics of family counselling. Moscow. M.: Gardariki. Eidemiller, E.G. , Dobryakov, I.V., Nikolskaya, I.M. (2005). Family diagnosis and family psychotherapy. SPb.: Rech. Muntean, A. (2011). Trauma of abandoned children and adoption as a promoter of a healing process. Today's Children are Tomorrow's Parents. 30/31, pp. 54-60.
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Building resilience in mother-child residential centers: risk and protective factors Arace A., Scarzello D. Department of Philosophy and Educational Science, University of Turin, Italy
[email protected],
[email protected]
Abstract Objective. The research analyzes, through a survey follow-up with a sample of 64 mothers entered, on submission of the Juvenile Court, in a mother-child assisted living center in Northern Italy, the variables that influenced the success (child custody to the mother with the project of autonomy of the family) or failure (children abandoned by their mother or given up for adoption by the Court) of the paths in the residential center. Design. In line with the model process-oriented [1, 2], which emphasizes the interplay between amplification and reduction of risk and following the distinction of Baldwin et al. [3], we analyzed the role of the individual, familiar and contextual distal and proximal risk factors, and proximal protective factors in influencing resilience. Results. Regression analysis indicates that positive outcomes are possible when the amount of protective factors allows a compensation for the risk factors; among the latter, those that have the greatest impact on outcomes are proximal factors. Protective factors are able to counter the vulnerability caused by distal risk factors, supporting the parental resilience. Keywords: Mother-child residential centers, resilience, risk factors, protective factors, distal factors, proximal factors
Introduction The most recent studies on the evaluation of parenting skills in severely dysfunctional situations passed a conception of risk based on the model of linear direct causality or on the multifactorial causation perspective to adopt an approach defined process-oriented [1], which recognizes the complexity of dynamic between risk and protective factors and highlights the centrality of the mechanisms of resilience for the adaptation in adverse conditions [2, 4, 5]. In accordance with this dynamic perspective, objective of the study is to analyze the parenting under conditions of deprivation, as in the case of parent-child pairs in the residential centers, trying to identify the protective processes which, acting as compensation with respect to risk factors, can promote an evolutionary process, facilitating the recovery of responsive caregiving.
Methodology The sample consisted of 64 mothers, entered in a mother-infant residential center in Northern Italy with their children, on submission of the Juvenile Court, due to situations of serious injury to children (mainly neglect and maltreatment). The average age of the mothers was 26 years (23 years old at the time of child's birth), with a range from 16 to 44 years (d.s. 5.54); 31% of them has other children, in some cases (28.3%) already forced moved from the family. 54.7% of children are males and 45.3% are females; the range of age was, at the time of inclusion in the residential community, between 1 month and 6 years (48.4% aged less than one year, 34.4% between one and three years and 17.2% older than three years). The length of stay in the mother-child community is for 21.9% of mothers less than 6 months, for 43.8% between 6 months and 1 year and for 34.4% between 1 and 2 years. Through follow-up survey on mother-infant dyads, we identified two groups of subjects: in the first, accounting for 59% of the cases (which will be referred to as Resilient Group), the protective resources have allowed to recover an adequate parental function, resulting in custody of the child to the mother with a project of autonomy of the family unit; in the second, 41% of the cases (which will be referred to as Not-Resilient Group), dysfunctional dynamics have not changed significantly, resulting in interruption the relationship between mother and child (the children were abandoned by their mother or given up for adoption or custody by the Court).
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Through the comparison between the two groups, we tried to identify those factors that have supported, or vice versa inhibited, the mechanisms of resilience and adaptation. Variables selection was made on the basis of literature about the risk assessment of parenting skills in dysfunctional conditions (eg., [6], [7]). These variables were found in the information folders of the subjects, prior authorization in accordance with privacy regulations, and encoded in a checklist of 22 items able to detect the presence/absence of individual, family and contextual risk and protective factors, taking into consideration only those variables that could be reconstructed for all subjects. We have followed the distinction made by Baldwin et al. [3] between distal and proximal factors, already used in previous research [8]: the distal risk factors, while not exerting a direct influence on adaptation, decrease the ability to use personal resources to cope with the difficulties. The proximal factors constitute the "day to day" which directly influences behavior, and can amplify or reduce the risk.
Results 1.1
Distal risk factors
The distal factors considered concern the family of origin of mothers (in particular, the presence of psychopathology and/or dependency in one or both parents, separation or divorce of parents, abusive parents, children removed from their families) and the mother's experiences prior to the inclusion in the residential mother-child center (institutionalization, deviant behavior, addiction problems, forced removal of other children).
1.1.1 Family of origin of mothers The history of mothers’ childhood and adolescence reveals typical characteristics of multiproblematic families [9], with the presence of symptoms of psychosocial distress in multiple family members. The parental figures were often addicted to alcohol and drugs and/or had mental health problems. Most of the mothers in our sample experienced severely disfunctional primary relationships, where prevailed dynamics of conflict and violence both within the parental couple (as evidenced by the high number of separations and divorces), and between parents and children (as evidenced by the numerous situations of maltreatment or abuse), which led interventions to protect children: frequently more than one child was in fact removed from the family and included in residential communities for minors. Although these risk factors are present in both subgroups, in the life stories of Not-Resilient mothers it is observed a significant prevalence of addiction problems in one or both parents (Tab. 1): the importance of such distal risk factor is interpretable as a consequence of role reversals in attachment relationship [10] that often occur in families with addicted parents. Tab. 1. Problems in the family of origin: A comparison between Resilient and Not-Resilient group
TOTAL SAMPLE
RESILIENT GROUP
NOTRESILIENT GROUP
2
Cramer’s V
51.7%
66.7%
33.3%
ns
ns
64.5%
45.0%
55.0%
6.30 (p < .01)
.45 (p < .01)
76.3%
54.5%
45.5%
ns
ns
Maltreating parents
84.3%
50.0%
50.0%
ns
Ns
More than one child moved away from the family
84.6%
63.6%
36.4%
ns
ns
Presence of psychopathology in one or both parents Presence of addictions in one or both parents Separated or divorced parents
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1.1.2 Mother’s experiences prior to the inclusion in residential centers The majority of mothers in our sample had previous experiences of institutionalization (75%), addiction problems (64.5%) and deviant behaviors (58.3%), primarily related drug dealing and prostitution. In 28.3% of cases the Court has decreed the removal of other children. The presence of these risk factors increases the probability of a failure in the recovery of parental skills: in fact, all the mothers in the Not-Resilient Group did experience institutionalization, dependency and deviance (Tab. 2). Also the previous forced removal of other children is significantly higher in the group of Not-Resilient mothers: as evidenced by statistic analysis, this is the main risk factor that adversely affects the outcome: in fact it could reinforce, in the mother but also in the educators, an image of inadequate parent. However, distal risk factors analyzed are not deterministically associated with the inability to recover the parental function, as already widely supported in the literature and highlighted by the presence of these risk factors also in the Resilient Group, even if with lower degree. Tab. 2. Mother's experiences prior to entry into the Community: A comparison between Resilient and Not-Resilient Group
TOTAL SAMPLE
RESILIENT GROUP
NOTRESILIENT GROUP
2
Cramer’s V
Experiences of Community for Minors in childhood
75.0%
62.5%
100%
7.31 (p < .001)
.43 (p < .001)
History of addiction
64.5%
52.4%
100%
5.81 (p < .01)
.45 (p < .01)
58.3%
43.8%
100%
.51 (p < .01)
28.3%
3.8%
64.3%
5.71 (p < .01) 17.73 (p < .001)
History of deviant behaviors Other children removed by order of the Court
1.2
.67 (p < .001)
Proximal amplification and reduction risk factors Proximal factors analyzed are related to the mother, the child, the partner and community context.
1.2.1 Proximal amplification risk factors Among the maternal proximal amplification risk factors, we considered the presence of maternal psychopathology and abusive relationship with the child. Mental health problems (borderline personality disorder, intellectual retardation and severe depression) affect the 37.5% of the sample, resulting an important proximal risk factor: 68.2% of psychopathological mothers is part of Not-Resilient group, while only 31.8% is part of Resilient Group (Tab. 3). The 50.9% of the mothers is also abusive or neglectful; 87.5% was in turn victim of abuse within the family during childhood. Having behavior of maltreatment to the child is a relevant amplification risk factor: 70.8% of maltreating mothers is part of the Not-Resilient Group, while only 29.2% is part of Resilient Group (Tab. 3). This result underscores that the risk is further connected to intergenerational transmission of traumatic experiences, caused by the absence of reduction risk factors rather than having lived such experiences in the past: in fact, the majority of Resilient mothers, despite having been abused by their parents, not repeat such dysfunctional relationships with their children. Maternal age and child age don’t discriminate between the two groups. Instead, it is an observable effect of the variable child's gender: male children are more at risk of maltreatment (67.7% of the male children is physically abused by the mother versus the 27.3% of the daughters; Chi square 8.43, p < .001), as noted in the literature (e.g. [11]).
1.2.2 Proximal reduction risk factors Among the proximal reduction risk factors, we have taken into account the time spent in the residential community, the educational alliance with the community and the presence of a collaborative partner.
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The literature shows that the Community can creates the conditions for change internal working models constructed by primary dysfunctional relationships [12]. The time spent in the community constitutes a protective factor, which is directly proportional to the increase of cooperation in the educational project. Our data indicate that nearly 66% of mothers who have been in the residential center with their child for more than six months was able to activate a process of resilience, with a positive outcome. On the contrary, for 80% of cases in which the mother has been in the community less than six months, the outcome was negative (Tab. 3). Some longitudinal studies about institutionalized girls who are victims of violence and deprivation have identified the presence of a stable marital relationship as protection factor for the assumption of the parental role [13]. In our sample, the father of the child is often absent or unknown (43.8% of cases). In cases where mothers have instead a stable bond with the baby's father, often partner has problems of addiction to alcohol and drugs (26.6% of cases), deviant behavior (14.1% of cases) and is abusive towards his female partner (29.7% of cases) and children (7.8% of cases). The presence of the partner often doesn’t support the path of evolutionary maternal change, reproducing the dysfunctional dynamics of her previous history. This means that the mere presence of a stable bond is not a protective factor that increases resilience, while determining factor is the active collaboration of the partner in the educational project. Only in 26.6 % of cases it was possible to obtain a collaboration of father with a supportive role to the mother: in these cases the path in the community often ended with the independence of the whole family. Instead, in cases where the partner was hostile toward educational intervention, the project often ended in failure and the forced removal of the child (Tab. 3). Tab. 3. Proximal amplification and reduction risk factors: A comparison between Resilient and Not-Resilient Group
TOTAL SAMPLE
RESILIENT GROUP
NOTRESILIENT GROUP
2
Cramer’s V
37.5%
31.8%
68.2%
6.45 (p < .01)
.50 (p < .01)
Abusive relationship with the child
50.9%
29.2%
70.8%
22.76 (p < .001)
.69 (p < .001)
Presence of a collaborative partner
26.6%
93.8%
6.2%
10.67 (p < .001)
.45 (p < .001)
Time spent in the Community (more than 6 months)
78.2%
66.1%
33.8%
7.78 (p < .05)
.37 (p < .05)
Presence of an educational alliance with the Community
65.6%
77.5%
22.5%
18.94 (p < .001)
.57 (p < .001)
Presence of psychopathology
Overall it can be concluded that the presence of abusive relationship with the child is the most significant amplification risk factor, while both the presence of a collaborative partner and the construction of a educational alliance with the community constitute important protective factors.
1.3
Resilience: Between risk and protective factors
The next step in the analysis was to compare, using analysis of variance, the two groups of mothers in relation to the weight of the risk and protective factors as a whole: the results indicate that the major differences in the two paths concern the proximal factors: the proximal risk factors are significantly more numerous in the Non-Resilient Group (F(1, 56) = 22.68, p A historical review of the construct. Holistic Nursing Practice, 18, 3-8. Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child development, 71, 543-562. Rutter M. (2007). Resilience, competence and coping. Child Abuse Neglect. 31, 205-209. Aldwin, C. M. (2007). Stress, coping and development. 2nd Edition. The Guilford Press. London. Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing Forum, 42(2), 73–82. Hardy, M. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Trauma Stress. 9, 3-23 Knight, C. (2007). A resilience framwork: Percpectives for educators. Health Education. 107(6) 543-555. Ellis, B. J., & Boyce, W. T. (2008). Biological sensitivity to context. Current Directions in Psychological Science, 17, 183-187. Hardy, S. E., Concato, J., & Gill, T. M. (2002). Stressful life events among community-living older persons. Journal of General Internal Medicine, 17, 841-847. Hardy, S., Concato, J., & Gill, T. M. (2004). Resilience of comunity-dweling older persons. Journal of American Geriatrics Society, 52 (2), 257-262. Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child development, 71, 543-562. Hogan. M. (2005). Physical and cognitive activity and exercise for older adults. International Journal of Aging and Human Development, 60, 95-126. Taylor-Piliae, R. E., Haskell, W. L., Waters, C. M., & Froelicher, E. S. (2005). Change in perceived psychosocial status following a 12-week Tai Chi exercise programme. Journal of Advanced Nursing, 54, 313–329.
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[24] [25] [26] [27] [28] [29] [30] [31] [32]
Mitrou, P. N., Kipnis, V., Thiebault, A. C., Reedy, J., Subar, A. F., Wirfalt, E., Flood, A., Mouw, T., Hollenbeck, A. R., Leitzmann, M. F., & Schatzkin, A. (2007). Mediterranean dietary patter and prediction of all-cause mortality in a U.S. population. Archives of Internal Medicine, 167, 2461–2468. Deegan, P. E. (2005). The importance of personal medicine: A qualitative study of resilience in people with pscyhiatric disabilities. Scandinavian Journal of Public Health, 33 (Suppl. 66), 29-35. Netuveli, G., Wiggins, R. D., Montgomery, S. M., Hildon, Z., & Blane, D. (2008). Mental health and resilience at older ages: Bouncing back after adversity in the British Household Panel Survey. Journal of Epidemiology and Community Health, 62, 987–991. Hildon, Z., Smith, G., Netuveli, G., & Blane, D. (2008). Understanding adversity and resilience at older ages. Sociology of Health and Illness, 30, 726–740. Montross, L. P., Depp, C., Daly, J., Reichstadt, J., Golsban, S., Moore, D., Sitzer, D., & Jeste, D. (2006). Correlates of self-rated successful aging among community-dwelling older adults. American Journal of Geriatric Psychiatry, 14, 43–51. Hildon, Z., Montgomery, S. M., Blane, D., Wiggins, R. D., & Netuveli, G. (2010). Examining resilience of quality of life in the face of health-related and psychosocial adversity at older ages: What is “right” about the way we age? Gerontologist. 50, 36–47. Heisel, M. J., & Flett, G. L. (2008). Psyhological resilience to suicide ideation among older adults. Clinical Gerontologist, 31(4), 51-70. Edward, K., Welch, A., & Chater, K. (2009). The phenomenon of resilience as described by adults who have experienced mental illness. Journal of advanced Nursing, 65, 587-595. McFadden, S. H., & Basting, A. D. (2010). Healthy aging persons and their brains: Promoting resilience through creative engagement. Clinics in Geriatric Medicine 26(1), 149-161
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Loss of life whilst still alive: Improving resilience and attachment with older people and people with dementia through the application of ‘NeuroDramatic Play’ Jennings S. Leeds Metropolitan University United Kingdom, Taiwan University of the Arts
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Abstract Much is known about attachment and resilience with children and teenagers. However the loss of attachments and decrease in resilience in later life has less research and implementation of policies and funding. Dementia is on the increase and many care homes and carers implement a system of benign dependency, with medication for 'difficult' individuals, rather than paying attention to the personal and social fabric in the individual's history and current difficulties. This presentation illustrates how a programme of Neuro - Dramatic Play with people with dementia can improve well being, slow down deterioration, improve social relationships and influence independence. The presentation will be illustrated with Power Point slides.
Introduction Ever since the pioneering work of Bowlby (1965), who was ostracized by the psycho-analytic movement, greater attention is being paid to the effect on children of early disrupted or disorganized attachment relationships. Following ‘hard upon’ was the emergence of a greater understanding of resilience with the outstanding contributions from one of our key speakers, Boris Cyrulnik (2005, 2009), whom I honour and appreciate with this presentation. These powerful influences from attachment and resilience led me to re-consider early infant development in relation to the importance of ‘playfulness’. As I asked a colleague, ‘What is the ‘ness’ in being playful?’. Can we also suggest there is a concept of playfulless? There is now limitless literature on play, play therapy, attachment but the writing is still not joined up. Then came the first research project. An intensive programme was planned for 9 children aged between 8 and 11 who have been excluded from school, or who have severe behavioral and emotional difficulties. Volunteers meant that each child had a significant adult within the group as a whole. The six days were divided in to 2 days of physical and rhythmic activities (embodiment), 2 days of painting and modelling, (projection) and 2 days of drama and stories, (role), based on the EPR developmental paradigm (embodiment-projection-role), [5], [6], [7], [8], [9]. Also, through the pairing with an adult, each child was able to explore risky actions, such as standing on each other’s backs or shoulders, within the safe containment, of being ‘held’, rocked or cradled, or working in a circle with a large parachute that connected everyone together. The sessions did not progress as planned as any attempt to introduce any drama work or masks was immediately rejected and the children became very disruptive. They did not want to engage in any role activities. However a return to the physical and sensory sessions immediately calmed everyone down. There was one role that all the children coveted, that was preparing and serving food and dressing up in a chef’s hat and apron. I reflected and then shared with staff what could be happening. It was very significant that the children in particular wanted to stay with the rhythm and drumming work 1. 2. 3. 4.
They requested repeats of the face and hand massage They enjoyed taking physical risks when supported by their adult partner They enjoyed ‘messy play’ with finger paints and clay. They wanted to be a part of the food preparation, serving and also sharing. They enjoyed sitting with the adults and talking
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I suggest that sensory and rhythmic play belong to the very early stages of child development, and that ‘playing at chef’ is dramatic play rather than sustained role play or drama. Being involved with food is also one way of satisfying emotional hunger. Having closely observed the children’s behaviour for the remainder of the programme, they thrived on the physical, sensory and rhythmic play, with some dramatic play. I suggest that these children were all functioning at an emotional age of 18 months - 2 years. It made complete sense that they could not play roles, (not that they would not). This led to detailed observation of the earliest stages of development, before and immediately after birth, in relation to ‘embodiment’ – the first stage of the EPR paradigm. This evolved into a more detailed analysis of mother-infant playfulness and culminated in a second paradigm ‘Neuro-Dramatic-Play’, which takes place 6 months before birth and six months after birth. Now that more is understood through neuroscience in relation to attachment, playfulness and the function of the mirror neurons [2], [11], one can see the importance of the attachment process from conception rather than developing by the end of the first year. Neuro-DramaticPlay is composed of: sensory play, rhythmic play and dramatic play, and is navigated through the ‘dramatic response’ (DR) or ‘as if’ stage which occurs within a few hours of birth. The DR is the imitation by the new born infant of the expression on the mother’s face. The infant is engaged in an act of drama, usually before he or she experiments with sounds. Understanding Neuro-Dramatic-Play at the start of life led me into consideration of its relevance towards the end of life. As an anthropologist I had saturated myself in the life of the Temiar tribe in the Malaysian rain-forest. Although I was looking at the role of the arts and culture in child-rearing, that led to noncompetitive adults, [6], I was looking at the context of the life-span. The stage of ‘wisdom’ rather than the stage of ‘fertility’ is marked by change of name, relaxation of food restrictions, and senior roles in the community. The Temiars traditionally show great respect towards children and older people. Older people are seen as a source of wisdom and experience. Their comment to me about young teachers was ‘How can they teach others? They have not lived long enough themselves!’ The prevalent attitude towards older people in the west is one of indulgent care, with the expectations that they wish to sit still, listen to music, and have decisions made on their behalf. We rarely consult older people, (apart from the judiciary and House of Lords), and older people have few opportunities to make their own choices. In NDP terms, older people are almost working in reverse of the developmental processes of small children: there are fewer opportunities for sensory stimulus and creativity, a weakening of thought processes, loss of attachments and relationships, (home, pets, interests); there are also fears of dependency, falling, loneliness, intruders, isolation, forgetting; deterioration of hearing, sight and memory. ‘The Tempest in my mind doth from my senses take all feeling else’ (Shakespeare: King Lear) Medication is seen as the first treatment rather than the last. If people are confused they are deemed to be not capable, whereas the use of the arts and storytelling, especially in dementia care have shown that memories can be retrieved and lucidity can improve. The application of NDP in ageing can help the loss and grieving process, encourage new attachments, enhance sensory integration, and promote existing skills and experience. But most importantly, if resilience is strengthened, then everything else will follow. Resilience is often mistaken for being ‘difficult’ or ‘challenging’; older people who are feisty or contrary or original can suffer sarcasm or be ignored. I include ‘Theatre of Resilience’ as a culmination of a synthesis of NDP and EPR, where theatre is perceived as a social and collaborative activity around a script, story, ritual or traditional or cultural celebration. It involves movement and music, image making, rhythm and drumming, dramatization of stories. Scene 1: A multi-cultural production (with Israeli Arabs, Jews and Brits) of Lysistrata toured small theatre in Israel including a performance in a day-centre for people with dementia. The staff were worried that people would not ‘behave’ and might disrupt the play, and we reassured them that whatever happened was fine. There was an extraordinary piece of interactive theatre when a woman in the front row started to call out at Lysistrata, especially when she was confronting the Magistrate; the woman egged her on, ‘Go on Lysistrata, you just tell him – go on, you tell him’! When the play finished she said ‘I want to talk to that Magistrate!’ We set up the scene and all the outpourings of her anger were directed to this very authoritarian actor, as she attacked him with her handbag, but in role as Lysistrata and he stayed in role as the Magistrate. The next day I had a ‘phone call from the manager of the day-centre. She said that there were two things that she thought I would like to know. Everyone had arrived at the day-centre, and for the very first time, everyone had remembered what they did the day before. As we know it is usually the short term memory that is affected first in dementia. Then because of the sexual nature of the play, it enabled people to talk about sex. She went on to say that many of the carers were young and found any reference to sex by older people difficult to handle. However because the subject had been ‘distanced’ in the play, and there was a lot of humour around sexual politics, and bawdy innuendo, it had enabled a transition from their own lives, loves and struggles.
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Scene 2: In a residential care home with a large number of people with dementia we have put in place a weekly dramatherapist who works in the dementia unit using themed material, creative movement and stories. From time to time there is an intensive input to further extend her work. This session was bringing a holiday to the group since they were unable to go away on holiday. We planned a trip to the sea-side and set off by train, singing traditional songs; we played with sand and shells, created billowing waves with big pieces of blue fabric. There was a Punch and Judy show, a Magician and a fancy hat competition, enjoyed by 20 staff and the same number of residents. Then we caught the train home and then enjoyed potato chips in screws of paper, and some ice-cream. The residents participated fully and remembered other holidays and activities.
Reflections Intensive play and arts activities, as well as regular inputs to reinforce learning, contribute to an innovative approach for Creative Care of older people, especially those with dementia. Brains need stimulation or they will atrophy, absence of a familiar landscape often leads to depression. However it is often politically expedient to keep older people in a state of dependency, to blunt their senses through medication and to treat them as children who need to be indulged. Providing they are kept clean and fed what else is required? In some institutions even cleanliness and food are not achieved. Scandals in care homes are widespread and increasing. Perhaps we need to consider attitudes towards old age, before implementing new forms of activity and therapy. We need to decide whether older people can be respected for their age and wisdom, rather than deciding they are not productive and there are at the bottom of the heap for resources.
A Story for Resilience - Pele the Fire Child Many years ago in a village somewhere near Hawaii, there is a young girl called Pele who loves lighting fires. She loves the smell of the wood smoke, and the sound of the crackling twigs, and her eyes light up at the glowing embers and she can see all sorts of pictures and stories in the dancing flames. Soon the other children join her and together they roast vegetables and dance round the fire singing songs. The other parents come and visit Pele’s mother to complain at the bad influence Pele is having on their children. And Pele’s mother has to say to her daughter, ‘Pele, you are making our life very difficult here; people are complaining so you have to stop lighting fires’. Pele finds this very difficult but she really does try and it lasts for some days. But then the feeling is so strong that she goes off to find another place where perhaps they could light fires. She goes for a long walk and reaches a huge field, far away from the village. ‘Ideal for us’ she thinks, and she runs back to the village to tell the other children. They plan a picnic and go off for the day; drag logs and branches to make a fire and cook their meal. They told stories and sang songs and soon it is time to pack up. Just as they were putting out the fire, a man appears waving his arms and shouting. It is the farmer who owns the field and they all run as fast as they can back home. The farmer follows and starts knocking on the doors of the houses asking for the children who lit the fire in his field. The adults tell him to go to Pele’s house, which he does, and he speaks very angrily to her mother. Her mother talks to her again and says that this time is her last chance otherwise she will have to leave home. Pele is really sorry and tries very hard not do other things instead. But she still longs for her magical fires and keeps wondering whether there is another place. She and just some of the children decide to go off for the day, (the others were too scared of perhaps meeting another angry farmer). They walk for a very long way and find a place the other side of the forest on a piece of rough ground that does not appear to belong to anybody. They light their fire and sing and dance, but most especially they tell stories. They cook vegetables which especially sweet that day, little did they know that this might be the last time they had this adventure. Or maybe they did know and were determined to make it the best they had done. They go home happily and are not aware that the smoke is drifting upwards across the top of the forest towards the village. People open their windows and sniff: hm - wood smoke – Pele. Her mother is waiting for her and tells her that she has had her last chance and that she must leave. Pele packs a bundle, ties it to a stick, puts it on her shoulder and walks away. She looks after herself, cooking her food as she goes and soon she comes to the seashore. She lights a fire from driftwood and sits gazing out to sea, wondering what she will do next. A water sprite called Nimusha comes to speak with her and says that she does not like Pele lighting fires and that anyway she is stronger than she is. Pele challenges her to a trial of strength, knowing that she will win but since when has fire survived the strength of water! Nimusha creates a tidal wave that come towards the shore, Pele immediately turn it into a twenty-foot high jet of steam and laughs in triumph. She discovers it is rather nice making explosions under the sea and she causes all sorts of islands to form and some of them are volcanic. Soon she decides that she has created enough explosions and that it is time
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to make her own island. She creates the biggest explosion she has ever done and makes the volcano her home. She rides her chariot across the flames laughing as she goes and the young men of the village create games of prowess on the rim. The older people of the village decide to protect themselves and they make offerings of white sweet smelling hibiscus flowers and throw them into the crater. Meanwhile Pele is becoming calmer and is less angry and spends more time curled up asleep at the edge of the volcano having wonderful fiery dreams. And now, if you are visiting there, you may see a little old woman with gray hair and a tattered red shawl. And she may just come to you and ask you for matches and a candle. Pele still keeps her fire and if pressed, may even tell you a story or two. And her eyes will still light up at the memories of her fiery life.
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12]
Bowlby, J. (1965) Child Care and the Growth of Love. London: Penguin Cozolino, L. (2006) The Neuroscience of Human Relationships. London: Norton Cyrulnik, B. (2005) The Whispering of Ghosts: Trauma and Resilience. New York: Other Press Cyrulnik, B. (2009) Resilience: How Your Inner Strength Can Set you Free from the Past. London: Penguin Jennings, S. (1990) Dramatherapy with Families, Groups and Individuals. London Jennings, S. (1995) Theatre, Ritual and Transformation: The Senoi Temiars. London: Routledge Jennings, S. (1998) Introduction to Dramatherapy: Ariadne’s Ball of Thread. London: Jessica Kingsley Jennings, S. (2011) Healthy Attachments and Neuro-Dramatic-Play. London: Jessica Kingsley Jennings, S. (2013) 101 Activities for Empathy and Awareness. Buckingham: Hinton House Jennings, S. (2013) Creative Activities for Developing Emotional Intelligence. Buckingham: Hinton House Maclean, P.D. (1990) The Triune Brain in Evolution: Role of Paleocerebral Functions. New York: Plenum Winnicott, D. (1982) Playing and Reality. London: Penguin
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Sexual emotional health among vulnerable adolescents Mateos A., Fuentes-Pelaez N., Molina M.C., Amoros P. Département des Méthodes de Recherche et Diagnostic dans l’Education. Faculté de Pédagogie. Université de Barcelona, P. de la Vall d’Hebron 171, 08035 Barcelona. (ESPAGNE)
[email protected],
[email protected],
[email protected],
[email protected]
Abstract Teenagers go through a stage of life in which they live affectivity and sexuality with great intensity of a point of view as well as relational identity. Ways to design, understand and see the emotional and sexual relationships are determined by various factors such as culture, social context and home environment, among others. The promotion of emotional and sexual health (SAS) includes the development of a positive vision of affective relationships in which sexuality translates into satisfying experiences, safe, free of coercion, discrimination and violence. Following the model of determinants of health Dahlgren and Whitehead [1], we can observe that there is some risk factors and protective influence of direct and indirect health of people, as well as sexual emotional health of young people. Traditionally, the study of sexuality has been specifically focused on risk factors, placing the intervention since the risk (risk approach). In this communication the results found in qualitative research was carried out by order of the Department of Health of the Generalitat of Catalonia are presented. The technique of data collection was used in the focus groups. Participation in the research was 72 teenagers total. Specifically, we present the perception of adolescents in relation to their own emotional and sexual health and that of their peers, from the resilience perspective. It focuses attention on the factors that contribute to living sexuality in a responsible way. In conclusion, it should be noted that among the younger population wchich is in a situation of vulnerability, the emotional, affective and social variables are crucial in sexual risk behaviors. Keywords: emotional and sexual health; adolescents; resilience; vulnerability; social risk; affective and sexual education
Introduction La santé affective et sexuelle (SAS) est un droit de l'adolescent, et la promotion d'une sexualité responsable est un devoir des institutions publiques. L'adolescence est une étape de la vie où l'affectivité et la sexualité est vécue avec une grande intensité. L'identité sexuelle est formée avec le passage du temps et permet à la personne de formuler un concept de lui-même sur la base du sexe, le genre et l'orientation sexuelle, et développer socialement en fonction de la perception d'avoir leurs capacités sexuelles C'est dans cette étape que l'orientation sexuelle est définie et requiert le respect de l'autre pour que l'adolescent développe un concept positif de soi-même et se manifeste avec sécurité et liberté. La situation de vulnérabilité ou de risque social chez les adolescents peut être accompagnée des déficits affectifs importants, par la situation familiale, par la différence culturelle ou par le contexte social. La santé affective et sexuelle implique une vision positive vers les relations affectives et, donc, des expériences satisfaisantes, rapports sexuels protégés, libre de toute coercition, discrimination et violence. La promotion de la santé affective, sexuelle et reproductive inclut l’intégration de quelques facteurs de base définis par la World Association for Sexual Health [2]: reconnaître, promouvoir, garantir et protéger les droits sexuels de tous et les situer dans le contexte des droits humains ; avancer vers l’égalité et l’équité de genre; condamner, combattre et réduire toutes les formes de violence sexuelles; promouvoir l'accès universel a l’information complète et l'éducation intégrale de la sexualité; assurer que les programmes de santé reproductive reconnaissent le rôle central de la santé sexuelle; arrêter la diffusion de l'infection du HIV et d’autres STI; identifier, aborder et s’occuper des préoccupations, des dysfonctions et des problèmes sexuels ; aboutir à la reconnaissance du plaisir sexuel comme l’une des composantes essentielles de la santé et du bien-être global. Cette perspective multidimensionnelle et écologique de la SAS intègre les aspects émotifs, affectifs et sociaux, particulièrement importants chez les adolescents puisqu’ils sont en plein processus de construction de sa
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propre identité sexuelle, d’établissement de relations sociales et affectives, de construction du concept qu’ils ont d’eux-mêmes et de leur autoestime. En suivant cette ligne, l’OPS [3] remarque que l’affectivité, les émotions et le fait de tomber amoureux sont des éléments particulièrement importants à aborder pendant l’adolescence, à cause de l’intensité avec laquelle les adolescents vivent ces expériences. Le but final serait de promouvoir une sexualité responsable chez les jeunes. Dans les collectivités de jeunes en situation de vulnérabilité ou de risque social, cette nécessité est encore plus latente car dans ces collectivités l’existence de déficits affectifs importants est plus probable à cause de la situation familiale dans laquelle les jeunes peuvent se trouver à vivre et aussi de la différence culturelle ou de contexte social [4] . En ce qui concerne la dimension sociale, l’UNICEF [5] remarque l’importance de la dimension sociale de la sexualité, spécialement chez la population en situation de vulnérabilité, car une grossesse d’adolescente non planifiée peut produire des effets sur les conditions de vie (l’éducation, le projet d’avenir, des conditions convenables de logement, etc.). Lorsque les jeunes ont une perspective d’avenir positive, une grossesse qui n’était pas prévue peut avoir des conséquences négatives sur leur bien-être et sur leur avenir en retardant ou en arrêtant leur projet d’avenir. Selon le modèle des déterminants de la santé de Dahlgren et Whitehead [1], on peut remarquer que différents facteurs influencent de manière directe et indirecte la santé et aussi la SAS des jeunes. Quelques uns de ces facteurs peuvent avoir un lien avec : les conditions politiques, socioéconomiques, culturelles et environnementales, comme par exemple le lien avec l’école et les perspectives de travail [6] ; les conditions matérielles et les ressources limitées et les faibles perspectives et aspirations pour l’avenir [7] ; la communauté, comme par exemple, vivre dans des quartiers pauvres avec des taux de chômage et/ou de criminalité élevés [8]; la culture d’origine et la religion [9] [10] ; les facteurs en relation avec les réseaux sociaux et communautaires, comme par exemple la structure familiale et l’éducation familiale [11], la pression du partenaire et des amis [12]; l’absentéisme écolier [6] ; les facteurs en relation avec les traits personnels et les styles de vie [12], comme par exemple des croyances concernant la sexualité et la consommation de substances psychoactives ; etc. Afin de promouvoir la SAS dans une perspective écologique et de favoriser des relations affectives et sexuelles mûres, responsables et sûres il faut renforcer les facteurs de protection qui peuvent favoriser une perception positive et responsable de la sexualité et, par conséquent, prévenir des conduites à risque spécialement dans les collectivités en situation de vulnérabilité ou de risque social. Nous allons présenter les résultats liés aux perceptions qu’ont les jeunes en situation de risque social de leur propre santé affective et sexuelle et de celle de leurs pairs.
Méthodologie L'étude présentée ici est une recherche participée, à caractère qualitatif, de mode cooperatif.
2.1. Participants Ont participé à la recherche 72 jeunes, dont 65% de filles et 37,5% de garçons. 18,1% d’entre eux avaient un âge compris entre 12 et 14 ans, 40,3% avaient de 15 à 17 ans et 41,7% de 18 à 20 ans, de 15 origines différentes. L'origine la plus représentée est la marocaine dans 34,7% des cas, suivie de l’espagnole dans 20% et de l’équatorienne dans 12,5%. Le groupe de jeunes présente des caractéristiques communes, parce que beaucoup de jeunes des quartiers défavorisés sont issus de l’immigration.
2.2. Instruments L'information a été rassemblée par le biais de groupes de discussion, selon les âges (da 12 à 14 ans ; de 15 à 17 ans ; de 18 à 20 ans) ; ensuite on a élaboré les questionnaires correspondants, la fiche d'identification du profil de base des participants ; la fiche résumant les principales contributions du groupe, le processus de dynamisation et le climat créé.
2.3 Procédé On a créé 10 groupes de discussion (5 groupes composés de jeunes immigrants, 3 de quartiers défavorisés et 2 de jeunes sous tutelle). Les groupes de discussion ont été conduits par deux chercheurs selon les questionnaires élaborés. Les contributions de chaque groupe ont été enregistrées en version audio avec le consentement des participants et avec l’accord de confidentialité.
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2.4 Analyse des données L'information des groupes de discussion a été enregistrée en version audio et a été transcrite de manière littérale par la suite. À partir des données trouvées on a effectué l'analyse du contenu, avec le support du logiciel Atlas ti v.5.0. Les codes d'analyses élaborées ont été validés par des juges.
Résultats Nous allons présenter les résultats relatifs aux perceptions qu’ont certains adolescents de leur propre santé affective et sexuelle et de celle de leurs pairs, en focalisant l’attention sur les conduites à risque. En analysant les données on trouve des différences par sexe dans quelques conduites à risque. Dans le cas des filles, ces conduites à risque sont associées à des relations sexuelles impulsives, des relations après avoir consommé de l’alcool (cela démontre une perte de contrôle sur ses propres décisions et une vulnérabilité majeure) et à l’induction d’avortements. P1, filles de 12 à 14 ans, groupe CRAE. Dans le cas des garçons, on trouve des commentaires sur les conduites observées chez d’autres jeunes en relation avec la non-utilisation du préservatif, des croyances autour de la sexualité et des infections à transmission sexuelle. > P11, filles de 15 à 17 ans, groupe des quartiers défavorisés. > P8, garçons de 18 à 20 ans, groupe des quartiers défavorisés. > P10, filles de 15 à 17 ans, groupe des quartiers défavorisés.
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Confiance dans le partenaire. Cette raison apparaît principalement dans les groupes d’immigrants plus anciens.
P2, garçons de 18 à 20 ans, groupe d’immigrants. P6, filles, de 18 à 20 ans, groupe d’immigrants. -
Désire de grossesse (l’idéal de maternité). Cette raison se retrouve seulement dans le groupe sous tutelle (centres résidentiels d’accueil).
> P5, filles de 15 à 17 ans, groupe d’immigrants. P10, filles de 15 à 17 ans, groupe des quartiers défavorisés. -
Manque de confiance. On trouve cet argument seulement dans le groupe de 15 à 17 des quartiers défavorisés.
P7, garçons de 15 à 17 ans, groupe des quartiers défavorisés. P11, filles de 15 à 17 ans, groupe des quartiers défavorisés. -
Préférence d’autres méthodes. Cet argument est mentionné seulement par les garçons en faisant référence aux méthodes féminines.
P8, garçons de 18 à 20 ans, groupe des quartiers défavorisés. > P11, filles de 15 à 17 ans, groupe des quartiers défavorisés. 0,05). So, we can conclude that mother's Authoritative parenting style does not serve as a moderator variable. When the criterion variable was Reactive relational aggression, Adjusted R Square was enlarged (from 9% to 15%) once the interaction variable was brought into analysis. The Beta of the interaction variable was significant (-0,26, p0,05). So, we can conclude that mother's Authoritative parenting style does not serve as a moderator variable in explaining relationship between Proactive overt aggression and Impulsivity/Fun Seeking. When the criterion variable was Proactive relational aggression, Adjusted R Square was enlarged (from 7% to 13%) once the interaction variable was brought into analysis. The Beta of the interaction variable was significant
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(-0,26, p110), and those which express “suffering” (v37, pi>70), perceived as extremely present. The influence threshold 60 is also reached by other two negative values, “sabotage of the other” (v16) and “unpretentious conditions, poverty” (v21), but the total of the other value influences determines the prevailing of the positive tone discourse. The tonality of referential criteria shows us, on the superior generality level, the prevailing of the criteria centred on the “Individual”, to the detriment of those focused on “Community / Society”, “Culture” respectively. At the subordinated generality level we can observe the way the nucleus of the social representation is built around the discursive anchor of “the family” with the most numerous positive references (pi>130); the only criteria which can compete with family being the “self” criterion (pi>110), and the “other” criterion (pi>100) respectively, both oriented positive, and the criterion oriented negative – predictable through its memorial charge – “traumatic events”, where pi>110. If we treat these criteria distinctly, we can observe the positive projections on the “self”, confirming the egocentric construction of personality in a group context, although the collective actor investigated writes his retrospective scenario in the dramatic register. The above mentioned observation confirms the research in the field of social experimental psychology, which renders evident the role of appreciative projects on the “self”, with a view to acquire and preserve self-esteem (Baumeister, Tice, 1986; Higgins, 1989). At the same time the “other” remains a strongly polarized criterion, in which the positive and negative evaluations exceed the pi>90 threshold, which suggested us the need of shading the criterion in the future stages of the research; in the present form, the criterion is not sufficiently relevant. In other words, the “other” category
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is too diverse to be included in only one variable. Thus, it has been observed that a significant differentiation occurs between the “other” ethnic (“German”, “Hungarian”, “Jew”, “Bulgarian” etc) and the “other” regional (“Oltenian”, “Moldavian”, “Bessarabian”), the appreciations being, surprisingly, more positive in the first case. Another differentiation is also distinguished between the generic “other” (defined in global, mediated terms) and the individual “other” (defined in specific, not mediated terms). These findings led us toward the two subsequent shadings which would be proper to apply to this referential criterion. The less fortunate retrospective perception is achieved, predictably, around “traumatic events” and is partially compensated by the positive influence in the global portrait of valuing “work”. It is interesting to note the observation according to which all the political referentials (“authority”, “political categories”, “political discriminations”) are perceived negatively, suggesting that the whole traumatic existential line is associated with a political element appreciated as disturbing and discriminating, generating strong rejection. A last remark that should be made is that the general field of “culture”, although less influent, produces a positive global tonality – the positive referential values being more numerous than the negative ones with all referential criteria. Such a remark suggests that the private space, the space of celebrations and school space, which give substance to this field, are looked upon as a kind of “refuge” space from the aggressions of history, with its public register, impersonal and institutionalised. All previous findings strengthen the initial suppositions, according to which the historical and social dynamic significantly affects the discursive contextualization (therefore the corresponding articulation of referential criteria) of life stories. We start the discussion on one of the resources which has a remarkable heuristic charge offered by the methodology adopted – value portraits associated with referential criteria by examining the most relevant identitary profiles which later superposed and considered in their depth, will permit to catch the global selfimage of the population investigated. However, there is often a “diurnal other”, serene, and a “nocturnal” one, threatening, but these two categories do not superpose. The boundary that separates them is not an ethnic one, as we supposed, but rather a regional one, as well as one imposed by the image level structuring (generic / particular). One of the most solid referential criteria – through the number of evocations and valuations – remains the “family”, with a preponderant positive tonality. It is significant that the area dominated by positive values is the area of instrumental values (vi=1-20). The area in which the negative values are more present is that of finality values (vi=21-40). The message transmitted by the lines of this portrait seems to suggest that the family constitutes a knot of the social identitary representation. Such a conclusion stresses a fact ascertained by a previous field study, conducted in Belinţ, which discovered family as a “source of stability and permanence” [1], in an environment perceived as hostile, through which the community can survive the earthquakes of history. The relative level II values reconfirm the importance conferred to faber values, but they regroup the self-fulfilling in another register. If Ae was on the second position as influence at level II, the structure of level II value categories undergo modifications, only slightly positive, giving way to relation values. Anyhow, all previous findings flagrantly contradict the ethic stereotype of the “Romanian passiveness”, bringing into forefront the responsible commitment and work values. We have realized a comparison among the finality values, which once acquired introduce the social actor in the register of “to have” and the instrumental values, focused on the register of “to be”. We observe that the continuous presence of work and of assuming one’s destiny – represented by the territory of “to be” – is more extensive than the territory which places the subject in the register of “to have”, stressing an important reconstruction of the existential paradigm for those confronted with a threatening and unsettled history. Quite often in the retrospective discourse, the memory becomes a support for the rehabilitation of the identitary type, and the recovery takes place rather symbolically and, in any case, in another dimension. Several subjects affirmed in an unburdening refrain, even if “we have lost everything” – goods, houses, lands, a life’s acquisition, “our children achieved themselves”, becoming over years doctors, engineers, professors. Thus, the dispossession in the register of “to be”, suggests a change of the orientation frame of the identitary nucleus, which is now valued through another attitude and value opening. The analysis of the relative level I values presents us an overwhelming prevalence of the instrumental values, stressing the previous finding according to which the pressures of history do not determine only a weak retort of its subjects but also an engaging and responsible one, which rather hypostatises the struggle with history and destiny, than their passive and inert acceptance. Thus, the vocation of communities to mobilize real identitary strategies when confronting with an unfavourable social context is reconfirmed [9], precisely to confer coherence to its own existential line and to master the contextual determinations, activating communitarian resilience [10]. We are stressing that in the extenso form of the research we can also follow the articulations of the “other” image through the portraits of each ethnic group or regional identity, and we can examine the construction of the diachronic identitary dimension by revealing the contrast between the accomplished “Banat of yesterday” and “the Banat of today” perceived as disappointing [1].
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Conclusions regarding self narrative strategies in traumatically events Starting with an initial intuition, offered by the construction of a field in Belinţ village in 1996-1997, on the traces of the Banat-Crişana Social Institute team of the 1930s, and achieving a comparative analysis of the two researches, we can render evident an unexpected constancy of social attitudes confronted by the main communitarian and institutionalised instances (from the same pattern of the distribution of authority within the family, to the same reference type of the “institutional other”: priest, mayor, clerk), even if the composition of the community has been changed throughout all these decades. Similar social conduits suggest the presence of a mental matrix which has not modified its dominants concerning its defining features. Therefore we have tried to direct our analysis to the territory of Banat, regarded as a collective character, which has preserved its profound mentality to a longue durée in the confrontation with the waves of history of this cultural area, which has succeeded in transgressing all the conjunctural cleavages. The complexity of such a territory of investigation imposes an adequate methodology as well. We have chosen the study, through content analysis, of a sample from the Archive of the Cultural Anthropology and Oral History Group, being aware that we will be able to catch only a tendentious portrait. We have localized three large thematic registers, centred on the individual, community-society and culture, which in their turn are grouped around the “self”, around the images of “home”, the “other”, “family”, celebrations”, “traumatic events” “political discriminations” and so on. At the same time, we have applied a multilevel value scale to such a discursive thematic destructuring, which differentiates between the instrumental and the finality values. From the retrospective discourses, in the thematic area of the “individual”, the “self” constructs itself a positive identity, confirming the theories of the social identity, which argue the decisive role of self-respect in the interpersonal balance and the seeking of a positive social identity within the affiliation group [11]. Such a strategy is mainly achieved by out-group differentiation, the “other” oscillating between the radical alterity (“it is another world”) and total similarity (“they are like us”). Along the discourses, the profile of a traumatic identity is born, which finds its refuge in the nucleus of the family. The “family” appears most frequently mentioned in discourses, reuniting, at the same time, most of the positive valuations of all the referential criteria, facing a contorted history, but over which is capable of projecting a serene light resulting from a superior retrospective understanding which acquires a new meaning. The self-narrative evoked by K. Gergen [5] is outlined, conferring coherence to the past and teaching the social actor to look upon the existential drama serenely and to heal through words, as well. At the level of social representation of the memorial identity, the “family” references are imposed in a symbolic confrontation with categories associated with “trauma”. Thus, the narrative anchors related to “family” become the most influent categories of memorial discourses, representing the core of self-identification in biographical overview. As for the value scale, out of over 2700 axiological references, we can distinguish the predominance of the values which would integrate in the register of “to be”, to the detriment of the “to have” values. Even if “destiny”, as well as “history”, have deprived the discursive actors of wealth, stability, social position, but all the existential breakings and all the discriminations they have lived are but the motives of a superior understanding of life, of the lasting and authentic friendships acquired, of the special achievements of their children, therefore, of certain acquisitions in the register of “to be”, which prove stronger than the misfortunes of fate.
References [1] [2] [3] [4] [5] [6] [7] [8] [9]
Gavreliuc, A. (2003/2006).Mentalitate și societate. Cartografii ale imaginarului identitar din Banatul contemporan. Timișoara: Editura Universității de Vest. Kaufmann, J. Cl. (1998). Interviul comprehensiv. In Fr. de Singly, Al. Blanchet, A. Gotman, & J. Cl. Kaufmann (eds.), Ancheta şi metodele ei: chestionarul, interviul de producere a datelor, interviul comprehensive (pp. 201-310). Iaşi: Polirom. Todorov, T. (1998). Les abus de la mémoire. Paris: Arléa. Vultur, S., & Onică, A. (2009). Memoria salvată, (II). Cine salvează o viaţă salvează lumea întreagă. Timișoara: Editura Universității de Vest. Gergen, K. (2009). Relational Being. New York: Oxford University Press. Bertaux, D. (1997). Le récit de vie. Paris: Nathan. Chelecea. S. (2010). Metodologia cercetării sociologie. Metode cantitative și calitative. București: Editura Economică. Iacob, L. (2004). Etnopsihologie și imagologie. Iași: Editura Polirom. Camilleri, C., & Vinsonneau, G. (1996). Psychologie et culture: conceptes et méthodes. Paris: Armand Colin.
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[10]
Werner, E. E. (1995). Resilience in development. Current Directions in Psychological Science, 4 (3), 81– 85. [11] Tajfel, H., & Turner, J. C. (1986). The social identity theory of intergroup behaviour. In S. Worchel., & W. Austin, (eds.), Psychology of intergroup relations, Chicago; MI, Nelson Hall.
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Risk and protection in mental health among Syrian children displaced in Lebanon Giordano F.1, Boerchi D.2, Hurtubia V.1, Maragel M.3, Koteit W.3, Yazbek L.3, Castelli C.4 1
Resilience Research Unit,Department of Psychology, Catholic University of Milan (ITALY) Social and Developmental Psychology, member of Resilience Research Unit, Department of Psychology, Catholic University of Milan (ITALY) 3 Himaya ONG (LEBANON) 4 Resilience Research Unit, Department of Psychology, Catholic University of Milan (ITALY)
[email protected],
[email protected] 2
Abstract Resilience is a process shaped by the interaction of risk and protective factors operating across the different layers of child’s social ecology. This paper examines the overall adjustment of 159 Syrian refugees children, living in collective shelters in different area of Lebanon, through investigating the variety of multilayered stressors and protective processes impacting their mental health, from individual characteristics to environmental mediators. The sample is divided into 4 groups according to the region where they are located: Akkar, the Bekka, Mount Lebanon and Beirut. The methodology employed combines qualitative and quantitative measures. Symptoms of child post-traumatic stress disorder and co-morbidity and psychosocial functioning, are collected through self report scales for children, parents and social workers, validated in Arabic language. Resilience measure includes items based on key actors perceptions of children needs and main resources. Specific drawing tools are employed in order to take into account children’s own perception of risk and protective factors in their life. Results enable to define good practices of “assisted resilience”, in orienting and optimising NGO psycho-social interventions with refugees children, families and community. In particular the awareness of protective process, allow practitioners to identify the main resources which can be improved and reinforced through psycho-social interventions. Risk factors lead to define criteria for detecting and monitoring more vulnerable cases. Keywords: Resilience, PTSD, Children, War, Refugees.
Introduction Since the beginning of the civil war in Syria in March 2011, nearly 2.5 million people were forced to be displaced [1]. Lebanon has welcomed more than 900.000 Syrian refugees (36% of all Syrian refugees) [2], [3]. Shelter is a serious problem for this large population and more refugees are gathering in informal settlements like camps which present extremely critical life conditions [3], [4]. These conditions accrue the deep sufferance caused by the traumatic experiences of war, violence and forced displacement. War experience can generate a variety of psychological and psychiatric consequences, which could range from adaptive responses to diagnosable psychiatric disorders [5]. Researches on mental health of youth victim of war and displacement have revealed a high presence of post traumatic stress disorder [6], [7], [8], [9], [10], [11], [12]. Resilience is the capacity of a dynamic system to recover from traumatic experiences which threaten its development [13]. It is shaped by the interaction of risk and protective factors operating across the various ecological systems of child’s social ecology [14]. Risk factors, lead to increased likelihood of maladaptation. Protective factors are predictors of lower levels of psychological symptoms [15]. In the last three decades resilience paradigm has been guiding research and practice focused on mental health of children victims of armed conflict and displacement aimed at understanding and improving the adaptation of children victims of extreme adversities [15]. Intelligence, self regulations skills, meaning and hope in life, agency, religious beliefs that finds meaning in suffering, adaptability, temperament and self-esteem appear to be the main individual protective factors [13], [15], [7], [16], [17].
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Family cohesion, support and communication, secure trust, strong bond between the primary caregiver and the child, child’s trust in their parent’s abilities to protect them against danger, parental psychological health and parent’s educational level result key family protective factors [13]. Community support, particularly available in peers networks and in school, are considered vital environmental protective factor for individuals [5], [15], [18], [19]. The main risk factors detected in children victims of war and displacement are the number of traumatic experiences before arrival in the new countries and stressful events after arrival [6], [20]. Recent war exposure, being a victim or witnessing violent acts, being exposed to violent shelling or combat, personal life threat and life threat to loved ones, deaths of family member, being separated from parents and forced displacement emerged as the most traumatic experiences [21], [22], [23], [24], [25]. Stakeholders are particularly concerned with the impact of extreme adversities in children [13]. Risk and protective factors can become targets of intervention [19]. In this perspective, intervention research is designed by both field and research experts, with the goal of exploring capacities, at individual, family and community level, that allows to foster resilience in young victims. Important recommendations emerged from studies in this field. Researchers suggest a better interaction between qualitative and quantitative methodology to reinforce the selection and adaption of resilience predictors and outcomes [15]. Secondly they affirm that in child adaption process analyses it is important to refer to different developmental domains, such as psychopathology and psycho-social wellbeing [13], [26], [27]. Furthermore, the importance of providing input from multiple informants has been stated [13], in order to pursuit an “ecologically informed study of children’s adaptation following trauma” [28] Last recommendation concerns the importance of assuming child perspective, which should be distinguished and integrated with the adult's one [29], [30], [31]. “Above all, we need to listen to children. They can tell us better than any professional expert what war does to the human spirit. They have witnessed it, close up and defenceless. They have learned, as I did, that war is not good for children” [19]. Drawing represents an important media that allows children to express feelings and perception of their own internal world. A study on narration and drawings of Lebanese refugee children, victims of war, state that the origin of their own trauma wasn’t the war itself. The traumatic experience was the disruption of what they call “collective envelope”, which is “temporality”, in terms of past memory and future projection, and cultural and symbolic references. Significant life spaces, such as the child’s home, and the human affective environment, which has been forming his social context, got lost due to migration. At the same time, new places couldn’t be invested by the children, who felt therefore stranger to the new context and depredated of a part of Self identity [32].
Methodology 1.1
Objective
This study is aimed at identifying significant risk and protective factors, that shape the overall adjustment in Syrian children victims of war and displacement living in collective shelters in different area of Lebanon.
1.2
Sample
The sample is composed by 4 groups of Syrian refugees children, hosted in: two tented settlements in the Bekka region, in Zahle (Fayda Afandi camp) and in Taanail (Ssou camp); a group of collective shelters in the town of Bebnine; homes located in Zaatrieh, a dangerous town run by drugs lords and arms dealers. In the following tables the main characteristics of the sample are illustrated.
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TABLE N° 1 DISTRIBUTION OF SAMPLE ON KEY DEMOGRAPHIC VARIABLES Variables Gender Boy Girls Age ( X = 10,7 years) 7 years 8 years 9 years 10 years 11 years 12 years 13 years 14 years 16 years
1.3
%
Variables City of provenances Idlb Halab Cham Homs Raqqa Damascus City of residence Zhale Bebnine Taanail Zaaiterieh Type of dwelling tented settlements Shelter House
44,9 55,1
0,6 17,1 12,7 15,8 13,3 19,6 8,9 11,4 0,6
% 13,3 25,9 19,0 30,4 6,3 5,1 13,3 59,5 15,8 11,4 29,1 59,5 11,4
Measures
The methodology employed combines qualitative and quantitative measures. Symptoms of child post-traumatic stress disorder and co-morbidity are assessed through the Arabic version of the Post Traumatic Stress Reaction Checklist - Child version [33]. It presents three subscales, which correspond to the three main cluster of the PTSD in the DSM IV [34] Re-experiencing, Hyperarousal and Avoidance. The questionnaire is administrated together with the Child War Trauma Questionnaire [35], which assess children’s exposure to war trauma. Both measures are child self-report. Psychosocial functioning is measured through the Strengths and Difficulties Questionnaires (SDQ) [36], validated in Arabic language [37], [38]. It presents 5 subscales: Conduct problems; Inattention-hyperactivity; Emotional symptoms; Peer problems; Pro-social behaviours. It was completed by parents. Resilience was assessed through the Child and Youth Resilience Measure-28 items (CYRM-28) [39], expressly translated in Arabic by the Lebanese team of research. The instrument’s subscales are divided into individual resources, which includes individual personal skills, individual peer support, individual social skills; Care giver resources, composed by Physical Care giving and Psychological Care giving; Context resources divided into Spiritual, Educational and Cultural. Socio-demographic characteristics concerning the child were collected. Specific drawing ateliers, edited by the Team of the Resilience Research Unit of the Catholic University of Milan, have been employed in order to explore children’s own perception of: - the main risk and protective factors in their life (Under the Rain) [40] - significant internal and external resources (The Self Bag) [41] - the adaptation process to the new Lebanese reality in terms of significant places which the child has invested in Syria and in Lebanon (The Cardinals Points) [42] and in terms of what they felt they have left in Syria and what they have taken to Lebanon (My marks on the Earth) [43] - past and life history in terms of positive and negative memories (Time line) [44] - capability of projecting himself in the future (The wishes Chest) [45] The drawings activities have been coded through ex post content analysis, which leads to a classification of units of analysis into a set of categories [46], [47]. Specific domains of study of resilience research oriented the definition of categories [48]. Criteria of exhaustivity, mutual exclusivity and homogeneity have been followed in defining categories. In order to ensure objectivity, different researchers have been included in the codify phase [49].
1.4
Procedure
The field workers team was composed by 2 psychologists from Himaya NGO. Sample families has been recruited for the study through local NGO, tribal leaders and directly during researchers visit to the settlements. Informed consent has been signed by parents. The children were divided into groups, of approximately 20 subjects, following similar age criteria, guided by one researcher. The instruments have been administered through 6 2h30 hours sessions. The setting varied depending on the locations: in Zahle and Taanail in opens spaces of the camps, in Bebnine in the courtyard of the municipality, and in Zaaiterieh in the community centre “Voix de la femme”.
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Results Results are organized in two parts. In the first one, we will explore the relations between the single scales of the four instruments described above: CWTQ [35]; PTSRC [33]; SDQ [34] and CYRM-28 [39]. In the second part, we will explore whether children who expressed specific contents in drawings ateliers, differed in scales measure comparing to the ones who didn’t express them.
1.1
Relations inside the scales
CWTQ correlates positively with the three scales of the PTSRC: Re-experience .350 (p=.000); Avoidance .295 (p=000); Hyperarousal .326 (p=.000). It indicates, as hypothesized, that the Post Traumatic Stress Disorder is due, at least partly, to the frequency of negative war experiences. This scale correlates weakly with the scale Behavioural problems of the SDQ (,170; p=.033). PTSR is related also with the scales Emotional symptoms (Experience .354, p=.000; Avoidance .251, p=002; Hyperarousal .276, p=.000) and Behavioural problems (Avoidance .158, p=048; Hyperarousal .221, p=.008) of the SDQ and negatively with the scale Contest Educational, the importance to study in our life (Avoidance -.267, p=001; Hyperarousal -.161, p=.045). No relations were found between CYRM and both SDQ and CWTQ.
1.2
Relations between the scales and the categories of drawings, memories or wishes differed
1.2.1 CWTQ T-Student statistic has been used to estimate the significativity of the difference between subjects who express or not specific contents on each scales of the four instruments. The principals significant differences will be reported. CWTQ Scale has a range between 0 and 1. In the following table we report the main results obtained by relating drawing categories with CWTQ scale. Children who indicated bad memories of grief and armed conflict and the ones who expressed the future wish of their family recover and well-being reported higher exposure to war trauma. While desires concerning future educational pathway were more frequent in children with less exposure to traumatic experience. Table n° 2 Means comparison between children who express or not specific categories on cwtq CWTQ
Exposure to war traumas
Atelier
Categories
Time line
Bad memories
Cardinal points
Host. Country Self Relation
Wishes chest
Subcategories Grief Armed conflict Community centre Education Original Family
Presence mean ,36 31 17 20 35
Absences mean ,25 18 28 28 25
Mean difference ,11 ,13 -,11 -,79 ,10
Sig. (2tailed) 0,40 0,00 ,009 ,045 ,029
1.2.2 PTSRC PTSRC Scale has a range between 0 and 1. In the following table we report the main results obtained by relating drawing categories with PTSRC subscales. Children who expressed bad memories of grief and armed conflict had higher rates of the PTSD symptoms. While lower PTSD symptoms were typical of children who indicated self disappointment experiences as bad memories and community events as positive memories. Children who reported as risk factors war and violence experiences, but no negative perception of current environment, presented higher symptomathology of PTSD in the three clusters. The indication of school and places of worship in native country as significant places in child’s life was typical of children with higher level of PTSD symptoms. While school, home and community centre in the host country appeared as significant places in the drawings of children with less PTSD sufferance. Children with wishes concerning their own educational pathway showed lower level of PTSD, while the ones indicating wishes on their original family recovery and wellbeing reported higher PSTD complete symtpomathology.
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Table n° 3 Means comparison between children who express or not specific categories on ptsrc PTSRC
Atelier
Categories
Bad memories
Time line
Positive memories Reexperienci ng
Under the rain
Risk factors
Cardinal points
Host country
Wishes chest
Self Relation Bad memories
Time Line
Positive memories Under the rain
Risk factors
Avoidance Native country Cardinal points
Host country Self Relation
Wishes chest
Bad memories
Time line
Positive memories Under the rain Hyper arousal
Risk factors Protec. factors Native country
Cardinal points Host country
Wishes chest
Self Relation
Subcategories Grief Armed conflict Self disappointment Community event War and violence Current Environment School Community centre Home Education Original Family Grief Armed conflict Self disappointment Community event War and violence Current Environment School School Community centre Home Education Original Family Grief Armed conflict Self disappointment Community event War and violence Current Environment Family Open spaces School Places of worship School Community centre Home Education Original Family
Presence mean 60 52 34
Absence s mean 43 31 49
Mean difference ,17 ,21 ,16
Sig. (2tailed) ,031 ,001 ,017
34 51 37
50 26 52
,16 ,25 -,15
,007 ,000 ,007
15 15
49 50
-,34 -,35
,000 ,000
14 21 62 68 52 28
49 51 43 40 30 51
-,35 -,30 ,19 ,28 ,20 -23
,000 ,000 ,016 ,004 ,005 ,005
32 50 35
51 24 51
-,18 ,26 -,16
,013 ,001 ,024
50 11 13
34 48 49
,16 -,37 -,36
,035 ,001 ,001
11 22 79 67 47 34
49 49 38 36 27 49
-,38 -,27 ,41 ,31 -,21 -,16
,001 ,003 ,000 ,00 ,001 ,017
24 47 32
46 20 48
-,22 ,27 -,16
,003 ,001 ,018
47 51 42 63 10 13
22 34 38 38 44 45
,25 ,16 ,04 ,25 -,34 -,33
,001 ,015 ,050 ,020 ,002 ,001
10 15 64
45 46 37
-,34 -,31 ,28
,001 ,000 ,003
1.2.3 CYRM CYRM Scale has a range between 1 and 5. In the following table we report the main results obtained by relating drawing categories with CYRM subscales. Children indicating grief negative experience presented less individual, family and context resources; armed conflict experience was reported by children with less physical care giving support and less educational resource. Children recognizing their past and present environment as risk factors presented more individual, family and context resources. Children reporting their own house, school and community centre in Lebanon as significant places showed higher resources in the three levels. While those who indicate Syrian urban points as significant places reported lower level of individual resources. Wishes concerning future education pathway were associated with higher family resources.
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Table n° 4 Means comparison between children who express or not specific categories on crym CRYM
Atelier
Categories
Individual personal skills
Time line
Bad memories Native country
Grief Urban point
Bad memories Risk factors Native country Host Country
Grief Past environment Urban point School Home Grief Current environment Urban point Home Grief Armed conflict School Current environment Community center Education Grief Current environment Community center Education Grief School Armed conflict Past environment Current environment School Community center Home Grief
Individual peer support
Cardinal points Time line Under the rain Cardinal points Time line
Individual social skills
Under the rain Cardinal points Time line
Physical Care giving
Spiritual
Native country Host Country Bad memories Risk factors
Under the rain Cardinal points Whish chest Time line
Psychological Care giving
Bad memories Risk factors
Under the rain Cardinal points Whish chest Time line My marks Time line
Host Country Self Bad memories Risk factors Host. Country Self Bad memories Leave Bad memories Risk factors
Under the rain Educational Host Country Cardinal points Cultural
Time line
Bad memories
Subcategories
Presence mean 4,10 4,00
Absences mean 4,46 4,41
Mean difference -,36 -,41
Sig. (2tailed) ,009 ,028
4,02 4,47 4,00 4,78 4,74 4,06 4,44
4.42 4,20 4,41 4,30 4,31 4,36 4,21
-,40 ,27 -,41 ,48 ,43 -,29 ,23
,020 ,037 ,028 ,022 ,035 ,036 ,027
3,94 4,60 4,26 4,51 4,87 4,71
4,36 4,27 4,65 4,72 4,52 4,50
-,42 ,33 -,38 -,21 ,34 ,21
,005 ,045 ,004 ,049 ,010 ,037
4,93 4,89 4,10 4,54
4,54 4,52 4,50 4,36
,39 ,36 -,40 ,18
,006 ,004 ,001 ,054
4,72 4,68 4,11 4,45 4,41 4,62 4,67
4,39 4,39 4,41 4,13 4,72 4,36 4,39
,33 ,29 -,30 ,32 -,31 ,26 ,28
,016 ,016 ,054 ,013 ,012 ,026 ,015
4,88 4,88 4,85 4,22
4,47 4,45 4,47 4,53
,41 ,43 ,39 -,31
,032 ,011 ,037 ,016
1.2.4 SDQ SDQ Scale has a range between 0 and 2. In the following table we report the main results obtained by relating drawing categories with SDQ subscales. Armed conflict experience was reported by children with lower level of pro-social behavior, and grief experience by the ones with higher peer relations problems. Community as protective factors was frequent in children with higher level of pro-social behavior and with less behavioral problems and less difficulties in peer relations. Even school and beliefs or faith reported as protective factors was associated with less problematic peers relations and less hyperactivity. Children who recognized their home, school and community centre as significant places show less behavioral problems and less emotional symptoms. Future wishes linked to educational pathway were associated with lower emotional problems, while the ones concerning original families recover and well-being were typical of children with emotional problems.
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Table n° 5 means comparison between children who express or not specific categories on sdq SDQ Pro-social behaviour Hyperactivity
Emotional symptoms
Atelier Time line Under the rain Under the rain
Cardinal points
Wishes chest Time line Behavioural problems
Peers relations
Under the rain
Categories Bad memories Protec. factors Protec. factors Native country Host country Self Relation Positive memories Protec. factors
Cardinal points
Host country
Time line
Bad memories
Under the rain
Protec. factors
Presence mean
Absences mean
Mean difference
Armed conflict
1,63
1,78
-,15
Sig. (2tailed) ,041
Community
1,79
1,65
,15
,059
Family Beliefs faith Place of worship
,84 ,66 1,16
,64 ,82 ,87
,20 -,15 ,28
,007 ,080 ,030
School Community centre Home Education Original Family Community
,50 ,65
,95 ,94
-,45 -,28
,001 ,017
,51 ,62 1,13 ,55
,95 ,96 ,87 ,73
-,43 -,34 ,26 ,17
,001 ,001 ,025 ,028
Community
0,54
0,72
-,18
,041
School Community centre Home Grief
,38 ,42
,70 ,70
-,31 -,27
,012 ,012
,40 83
,70 65
-,30 ,18
,013 ,019
Community School Beliefs faith
0,51 ,54 ,51
0,74 ,71 ,71
-,23 -,16 -,20
,001 ,034 ,009
Subcategories
Discussion The strong relation between war-related experiences and Post Traumatic Stress Disorder symptoms show the relevance of the traumatic experience reported in the CWTQ. The correlation between Post Traumatic Stress Disorder and child psycho-social functioning, is consistent with the clinical description of traumatic symptomathology in children. The weak relations between resilience measures, war-related experiences and social functioning appears in contrast with the definition of resilience as positive outcome despite adversities. Grief and armed conflict appear to be the main traumatic experiences as it correlates positively with symptomathology and negatively with resilience subscales. This results is coherent with the main risk factors illustrated by the literature [21], [22], [23], [24], [25]. The lower symptoms reported by children who indicated self disappointment experiences as bad memory can be due to one of the main peculiarity of traumatic experiences: they overwhelm the person, and induce the feeling of helplessness and hopelessness. Selfdisappointment experiences are due to self failures; therefore controlled by the individual. The second peculiarity of child war trauma that emerges through drawings ateliers is the disruption of his “collective envelope”,[32] and the consequent chaos of space-time dimensions. Significant life spaces of past reality represent still an important reference for the child, but they got lost due to migration and new places of present reality cannot be invested. The traumatic overinvestment in past reality emerged in the perception of different sites in native country as significant places, which appearesd frequent in children with higher PTSD symptomathology and lower level of individual resources. While the recognition of school, home and community centre in the host country as significant places is typical of children with lower PTSD sufferance, less behavioral problems and less emotional symptoms. Children who reported as risk factors war and violence experiences, but no negative perception of current environment, beside the several difficulties they are facing in the settlements, presented higher symptomathology of PTSD in the three clusters. The reason can be that traumatic events fixation doesn’t allow the child to detach from the memory of the event and to move on with the present reality. Findings on the positive adaptation of children who reported community, school and beliefs as protective factors are coherent with the literature [5], [7], [15], [16], [18], [26], [32]. Presenting future wishes concerning personal educational pathway may show the child capability of projecting himself in the future, where he will grow up and develop and therefore it’s frequent in children with less war exposure, lower level of PTSD symptomatology, resilient skills and less emotional problems. The high prevalence of psychological sufferance in children who reported future wishes of the original family recovery
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and wellbeing may indicate that they are still focused on reparation process from the impact of traumatic experiences which they still feel very present.
Conclusion This study presents typical limits of researches on extreme adversities, such as difficult availability of assessment tools suitable to the culture and situation, chaotic and hazardous settings due to the physical and political conditions, absence of pre-disaster baseline data, difficulties of engaging comparison groups and the lack of funds on this field [13]. And a very high rate of illiteracy among the children. But at the same time results appear to have implications for interventions aimed at protecting children, mitigating risks and promoting resilience. It’s important to be aware of the type of experiences lived by the child and to monitor the ones who has been exposed to high level of violence and grief. Restoring a sense of agency in child and supporting his investment in the present reality, starting from the everyday concrete places, such as personal settlement, school and community centre are fundamental protective factor. Finally future project and wishes concerning the child are important protective factors, which should be supported. Community, school and personal beliefs play a central role in the resilient process.
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Resilience throughout life: The narrative of a senior missionary kidnapped by Renamo Gonçalves M. Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Lisboa (PORTUGAL)
[email protected]
Abstract Active ageing is the process of allowing individuals to continue participating in social, economic, cultural, spiritual and civic issues independently of their age. Missionaries are members of a religious group sent to an area to do evangelism or other service ministries like education, literacy, social justice, health care and economic development. Based on a program we are experimenting in Portugal in order to develop individual active aging plans for missionaries who return from mission in retirement age, we will present a case study of a senior priest kidnapped by Renamo during his mission in Mozambique, Africa. Renamo (the Mozambican National Resistance) is a conservative political party in Mozambique, founded in 1975 following Mozambique's independence as an anti-communist political organisation, that fought against the FRELIMO in the Mozambican Civil War of 1980 and against the ZANU movement. We conducted 24 face to face sessions with this missionary, during which among others the priest wrote his life narrative. This narrative was subject of an analysis exploring stressors and resources. Being resilience the long-term capacity of a system to deal with change and continue to adapt and develop within critical thresholds, this case study brings an interesting insight to the actual uncertainty being again lived in Mozambique with several kidnappings. Keywords: active ageing plan, missionaires, kidnapping, life narrative, stressors and ressources, case study
Introduction Throughout life the human influences and is influenced by the environment. These influences and choices contribute to the quality of life at retirement age. Active ageing is the process of allowing individuals to participate in social, economic, cultural, spiritual and civic issues independently of their age [1]. The Model of Active Ageing presented by WHO [1] is influenced by several factors: personal (biological), behavioral (healthy lifestyles and active participation in the care of own health), economic policy (access to income and social protection), physical environment (safe neighborhood, safe food), social order (adequate social support, education) and social and health services (focusing on health promotion and prevention). This approach recognizes the importance of human rights of older people and the principles of independence, participation, dignity, care and self-actualization and encourages the responsibility of older persons in the exercise of participation in various aspects of their daily lives, based on health, security and social participation. Missionaries are members of a religious group sent to an area to do evangelism or other service ministries like education, literacy, social justice, health care and economic development. To be a missionary implies having good interpersonal relationships, adaptability to other cultures and emotional stability [2]. Navarra & James [3] founded in a study with 76 missionaires that missionary acculturation follows a similar stress/coping model as other sojourner groups, though that religious orientations differentially predict perceived stress. When missionaires achieve a senior age, usually 30/40 years being abroad, they go back to their home country due usually to their health condition. When back, they see a different country from which they left, and they don't understand their actual role. Some show decreased mobility, others lack of motivation of continuing active. As life narratives help seniors assign meaning to past action and events, sharing their knowlege with younger generations, this study aims to understand resilience throughout a life narrative of a senior missionary, identifying in each life stage stressors and ressources [4, 5, 6]. Based on a program we are experimenting in Portugal in order to develop individual active aging plans for missionaries who return from mission in retirement age, we will present a case study of a senior priest kidnapped by Renamo during his mission in Mozambique, Africa. Renamo, the Mozambican National Resistance, is a conservative political party in Mozambique, founded in 1975 following Mozambique's independence as an anti-communist political organisation, that fought against the FRELIMO in the Mozambican Civil War of 1980 and against the ZANU movement.
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Methodology We conducted 24 face to face sessions with this missionary, during which among others the priest wrote his life narrative. In session one an individual program was discussed and an agreement celebrated. Each session consisted of a one hour weekly meeting during which the psychologist read what the missionary wrote with pencil and paper, asked for more details and worked together age related doubts and anxieties as memory stimulation. The life narrative was subject of a content analysis exploring stressors and resources.
Results The life narrative can be divided into 5 periods: 1. Childhood, 2. Adolescence, 3. Seminar in Portugal, 4. Studies in Rome, 5 Misison in Mozambique. During childhood the main stressor we can find in the life narrative of this missionary is a punishment due to his bad behavior at school together with his classmates. As main childhood ressources we identify the priester invitation to the missionary to become his assistant at the church and his mother verbal approval after his decision to become a missionary. Now as senior, the missionary explains remembering these childhood moments that "time eassembled everything in its place" and that until today nothing could pull him from the road of being a missionary. During adolescence the main stressor we can find in the life narrative of this missionary is the feeling that something was missing. As main adolescence ressources we identify the priester multiple iniciatives, including the invitation to visit two seminars. Now as senior, the missionary explains remembering these adolescence moments that thanks God every five years he can change his life and that Priester's words helped him overcome difficulties and uncertainties. During the seminar in Portugal the main stressor we can find in the life narrative of this missionary is the fall from a tree and lost conscience. As main ressource during seminar in Portugal we identify the relationship with God. Now as senior, the missionary explains remembering these moments at the seminar in Portugal that it was the time he learned "that a disease is for each of us a very important life moment as we are visibly more dependent of God with our most vivid hope waking up our faith". During the studies in Rome we can find four stressors in the life narrative of this missionary: bad behavior in school room, difficult times due to Concil Vatican II, bike accident and bike theft. As main ressource during studies in Rome we identify the presence of his class mates. Now as senior, the missionary explains remembering these moments of studies in Rome that "after all God does as He wants even after we have submitted plans for how we think about doing. It is a very useful teaching for each of us". During the mission in Mozambique the main stressor we can find in the life narrative of this missionary is his kidnapping by RENAMO. As main ressource during the mission in Mozambique we identify his job prior to the kidnapping - the creation of 44 communities and the respective leaders for each of them. Now as senior, the missionary explains remembering the kidnapping by RENAMO in Mozambique that at first we was afraid to dye but said "Be what God wants". Though at the end he recognized the deep relationship of friendship between them and the military.
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Table 1.: Stressors, Ressources and Resilience at each life narrative stage Life Stage
Stressors
Ressources
Resilience
1. Childhood
school punishment due to behavior
Priester invitation to become his assistant
"time eassembled everything in its place" "I got enthusiastic for this great ideal and until today nothing could pull me from this road"
mother's approval to become missionary 2. Adolescence
feeling that something was missing
Priester invitation to visit "I thank God because in my life until today every five years I could change 2 Seminars my life" priester multiple "There were Priester's words that helped me overcome difficulties and iniciatives uncertainties of the way"
3. Seminar in fall from a tree and Portugal lost conscience
relationship with God
"It was also a special day where I learned that a disease is for each of us a very important life moment as we are visibly more dependent of God with our most vivid hope waking up our faith"
4. Studies in bad behavior in Rome school room difficult times due to Concil Vatican II bike accident bike theft
school mates
"After all God does as He wants even after we have submitted plans for how we think about doing. It is a very useful teaching for each of us"
5. Mission in Renamo kidnapping Mozambique
prior great job: creation "We said: Be what God wants...In that of 44 communities and moment I thought it was my last life leaders for each of them moment...To conclude I would say that the sacrifice that we did together missionarires and our friends the RENAMO military, generated deep friendship, the one that is not easy to separate from us. It was therefore difficult for each of us when it came the goodbye hour"
Conclusions The main aim of this study was to understand resilience throughout a life narrative of a senior missionary, identifying in each life stage stressors and ressources. The content analysis of the life narrative shows us that ressources are in all five life stages persons: priester, mother, God, class mates, communities/leaders. Stressors are therefore punishments, accidents and missings. Resilience is for this missionary related with time, ideal/road, change, words and faith/dependency of God. Being resilience the long-term capacity of a system to deal with change and continue to adapt and develop within critical thresholds, this case study brings an interesting insight to the actual uncertainty being again lived in Mozambique with several kidnappings.
References [1] WHO (2002). Active Ageing. A Policy Framework. [2] Pol, H. (1994). Missionary Selection, Stress, and Functioning: A Review of the Literature.Biola University [3] Navarra & James (2005) Acculturative stress of missionaries: Does religious orientation affect religious coping and adjustment? International Journal of Intercultural Relations, 29(1): 39–58. [4] Bronfenbrenner, U. (1979). Ecology of human development. Cambridge MA: Harvard University Press. [5] Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56 (3): 227–238. [6] Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57 (3): 316–331.
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Conceptualizing resilience: Dissociation, avoidance, and silence as resilient trajectories among former child soldiers and ex-combatants coping with past trauma and present challenges in acholiland, Northern Uganda Harnisch H.1, Knoop Hans H.2, Montgomery E.3 1
DIGNITY – Danish Institute Against Torture and Aarhus University (DENMARK) Aarhus University (DENMARK) 3 DIGNITY – Danish Institute Against Torture (DENMARK)
[email protected],
[email protected],
[email protected] 2
Abstract Studies of resilience in war-torn countries such as Uganda, Congo and Mozambique have broadened the field of resilience research [1, 2, 3, 4]. However “significant gaps in our knowledge about effective responses and factors associated with resilient outcomes and resilient trajectories” in these contexts prevail [5]. In 2013 ethnographic fieldwork was carried out among former child soldiers and ex-combatants from the rebel army The Lord’s Resistance Army (LRA) in Northern Uganda, Acholiland to explore coping strategies, demobilization and resilience in a context of severe adversity. The LRA is known for methods of brutal torture and use of child soldiers in their war against the Ugandan government using similar means. This paper rests on in-depth descriptions and emic notions of individual ex-combatant’s responses to such adversity. The responses associated with resilient trajectories and outcomes call for re-conceptualizations of resilience: In Acholiland `dissociation´, `avoidance´, and `silence´ and in some cases `appetitive aggression´ [6] seem key in resilient responses and coping. Thus resilience must be studied in a variety of contexts, based on what we know from resilience research [7, 8] but integrated with a culturally sensitive and individual differences perspective approach [9]. Not doing so puts the subjects we study at risk of being placed in confining categories of pathology, which in return puts scholars at risk of missing the opportunity to broaden and deepen our understanding of resilience. Keywords: Resilience, dissociation, coping, ex-combatants, child soldiers, Northern Uganda.
Introduction The paper derives from a study on resilience and coping strategies among former child soldiers (below 18 when abducted) and ex-combatants (above 18 when abducted or volunteering) from The Lords Resistance Army, originating from Acholiland, Northern Uganda. The PhD is a qualitative study using ethnographic fieldwork methods such as participant observation and reflection [10], repetitive narrative life story interviews, semi-structured interviews as well as resilience scales and questionnaires assessing relevant protective factors such as perceived social support, locus of control and life orientation [11, 8, 12]. In some cases, where additional consent had been obtained, video recordings inspired by “A day in a life method” [13] were carried out when the researcher and the female or male interviewee found it appropriate. This paper however will only make use of the data obtained during participant observation and reflection, interviews and videos. (N: 36. Females: 18 Age 16 – 38. Males: 18 Age 19 – 39)
When constructs and categories do not capture what is on the ground As explained in various articles resilience research originated from developmental studies of children growing up in chronically adverse environments [8, 14]. Since then the field has included studies of resilience as responses to singular traumatic events – in a recent paper referred to as `minimal-impact resilience´, which is
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different from `emergent resilience´; indicating the chronicity of adversity to which resilient responses might emerge [14]. A gap in the literature [15] thus exist on research in populations where chronic adversity has become long-lasting, affecting children and adults throughout their lifespan, and where the adversity is defined by both re-occurring acute stressors such as attacks or violent conflicts in a region, as well as chronic adversity in the form of poverty and political turmoil. This study was conducted in such a context in Acholiland, Northern Uganda. Our study of resilience among former child soldiers and ex-combatants from a context still struggling in its aftermath of war, has taken an explorative approach to identifying and defining what seems to be resilient coping in this context, precisely because the measurement tools and findings in resilience research at hand so far did not seem to adequately apply in this context of cumulative trauma and somewhat extreme adverse circumstances - and in some cases the data called for arguing against consensuses in trauma and resilience literature. As a result we suggest a framework for identifying resilient coping strategies and resilient coping, which takes departure in the situated living conditions and culture asking: What are the conditions for corresponding to established notions of resilience in this particular context? Arguing that in some contexts, trauma is so severe and cumulative, and uncertainty in the forms of poverty and political instability is so prevalent, that conditions are too un-ordinary to make use of consensual and categorical trauma related disorders [15, 16] and resilience constructs arrived at in contexts far from the one represented in this study. Along these lines our approach to researching resilience is particularly inspired by Bonanno and Burton [9] as well as Barber [15]. We aspire to their requests to pay increased attention to individual differences and providing detailed accounts of context. Bonanno and Mancini [7] in a groundbreaking article about ways forward in trauma and resilience research and beyond, critique traditional trauma theory for failing to grasp the full range of adjustment in the aftermath of potentially traumatizing events, and Bonanno and various co-writers in numerous articles describe studies (Mancini, Bonanno, & Clark, 2009, Curran & Hussong, 2003, Jung & Wickrama 2008, Múthen & Muthén, 2004 are referenced), which have “dramatically underscored the natural heterogeneity of human stress responding” [7 p. 76]. An additional important point set forth in the article is that studies of the latent structure of PTSD symptoms using taxometric analyses have consistently supported a dimensional rather than a categorical structure (Bonanno & Mancini 2012 referencing Broman-Fulks et al 2006, Ruscio, Ruscio & Keane, 2002). Thus: “PTSD is best understood as a continuous dimension ranging from mild to severe trauma rather than as a discrete clinical category; thus, any diagnostic cutpoint we might use will to some extent be arbitrary.” [7, p. 75]. The fieldwork in which this paper has its foundation supports these findings and analyses. Due to the context and population of this study, still rather uncommon in the resilience literature, our framework is eclectic and moves across approaches and paradigms in order to collect the most useful and applicable findings in the field of resilience research (O´Dougherty Wright, Masten & Narayan 2013, Masten 2011, Bonanno and Burton 2013, Bonanno and Dominich 2013, Betancourt and Williams 2009, Betancourt and Kahn 2008, Ungar and Liebenberg 2009, Carrey and Ungar 2007 to mention a few) to support our analyses of coping strategies and definitions of resilience as they emerged during the fieldwork among the female and male former child soldiers and ex-combatants in Acholiland. We are greatly inspired by Klasen’s term “posttraumatic resilience” [3] when defining resilience. Klasen et al research resilience in children (11-17) from Northern Uganda whom are former child Soldiers. Our study population is 16-41 years of age, with the vast majority above 18. The study is looking for detailed accounts of individual coping strategies rather than patterns across the study population. Thus our data calls for new conceptualizations and putting words and concepts to findings, we have not come across elsewhere in the resilience and trauma literature so far. Finally we focus on coping strategies, i.e. responses to the past cumulative PTE´s and present seemingly chronic adversity, which among other things characterize the Acholi context1. This has brought about the term “resilient coping”. Our focus on coping strategies means that we empirically explore resilience by observing, inquiring about and co-reflecting with informants on mental and behavioral responses to adversity, with the goal of identifying what seem to be resilient responses. In other words; coping strategies are perceived as resilient if they entail relatively desirable and constructive outcomes in a challenging context with a study population with a severely challenging past. This means we consider and research both resilient processes (coping strategies) as well as resilient outcomes: By resilient coping we mean the outcome of the coping strategies which former child soldiers and ex-combatants more or less consciously and voluntarily engaged/engage in - and how these coping strategies have influenced/influence past, present and potentialities of the future for instance in terms of vicinity of resources (out of reach, moving closer or still out of hand?), mental states, self-efficacy, own evaluations of life quality, quality of social relationships. All of these factors, we stress, 1
We favour Barber´s emphasis on contextualising resilience research. Publications in progress will provide lengthy accounts of the Acholi context; unfornuately it is beyond the scope of this congress paper to provide such.
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are always influenced by situational and environmental cues such as political stability, climate, and states of poverty (see section 5 for elaboration).
Outline The paper will present six markers we argue are crucial to paying attention to when researching resilience and if evaluating the resilience in responses to traumatic stress. The markers and the additional 5 criteria we use to define resilient coping are empirically based, but informed by existing literature on trauma and resilience research, as well as the gaps in the same literature we find essential to contribute to filling with empirically based knowledge. Due to the fact that 34 out of 36 informants were not part of any organization or NGO, which would address past trauma and facilitate interventions as part of a healing process; the data for the most part concerns mental coping strategies in general with dissociation, avoidance and silence as particular prevalent responses. This paper will conceptualize dissociation from diverging academic fields, to inform the empirical data and promote analysis of how dissociation, avoidance and silence in an Acholi context seem essential parts of resilient coping.
Relativity and traumatization: 6 markers that matter and complicate Traumatization and resilient coping co-exist in Acholiland, and, we suggest, in many other contexts too. We are aware that the experience of how detrimental adversity or potentially traumatic events is to your functioning, to your system and life is relative and thus it does not take a context of war or extreme adversity like Acholiland to argue for a critical reflection in application of standardized measurement scales of resilience and adversity. What is extreme is relative too as is what is traumatizing and to what extent disturbances in functioning are disturbing enough to be viewed as pathology. Based on fieldwork data from Acholiland and findings in trauma and resilience literature [17, 18, 15, 13], we argue that how much a traumatic event affects you depend on 1. 2. 3. 4.
The prevalence of trauma in the surroundings society (family and societal context) of the person studied. Occurrence of trauma (what type of trauma/number of PTE´s) in the individual person’s life. How emotionally sensitive the person is How much support the person has and what kind of support This also relates to cultural notions of suffering, coping and how to cope/heal/recover:
1. 2.
How much and how one is supposed to display emotional reactions to suffering, reflect on, talk about and share about pain and suffering (i.e. what is acceptable behaviour in a specific context? What can be talked about? What is taboo? Is rape? Is killing?) What financial and social resources are available? If everyday life consists of either surroundings of privilege in a highly effective performance society, or a less privileged society equally busy with managing to meet primary needs and ensure survival - this influences what possibilities, social scripts, time available and resources one has to engage in ones coping process.
Clearly all these factors play a pivotal part in a dynamic complexity, which human beings exposed to adversity navigate more or less constructively and successfully. What is considered constructive and successful will vary too in relation to what cultural and socio-economic context is in focus, as well as the cultural and socioeconomic context of the researcher influence what is noticed and how. In short; critical awareness of the ambiguity and shortcomings of resilience constructs and categorical diagnostic terms when describing and analysing responses to trauma in any given context is essential.
Five criteria for defining “Resilient coping” With the stories and admirable struggles of Acholi females and males in mind, we propose 5 criteria for defining resilient coping, which we realize are not measurable, but none-the-less can serve as a guiding tool when exploring resilience in a context of cumulative PTE´s and chronic adversity. We have chosen to call them abilities, referring to “being able to”. This connotes and promotes looking at actions and thus lived practices on the ground, which is a useful component when complementing, critiquing or revising measurement tools or diagnostic manuals. After these criteria we will use excerpts of elaborate case stories in order to serve our investigation of what coping strategies our informants have made use of (more or less voluntarily – this will be elaborated on) in order to enable resilient coping. We are aware that the following criteria as well as our perception of the coping strategies as relating to resilience can be provocative. We then again refer to the chronicity with which severe trauma occur in the context studied here.
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1)
2) 3)
4)
5)
Ability to actually survive through ambushes and a war known for its innate brutality and exploitation of the civil population in Acholiland. We realize that this also has to do with coincidence. But often stories of survival and escape spoke of tremendous courage, creativity, strategic planning, perseverance, self-control, and help from God, spirits or both, as well as avoidance, emotional numbing and compartmentalization. Ability to stay (relatively) sane through witnessing, carrying out or being target of ongoing atrocities such as repeated torture, rapes and killings. Ability to maintain daily functioning despite having experienced severe trauma: Relative maintenance of hope, will to live, self-efficacy, goals for the future. Ability to maintain ones daily functioning and ability to take care of primary needs. If a family caretaker; being able to feed and comfort children – unless poverty, present war and climate conditions inhibit one in doing so. Absence of chronic severe depression, re-occurring suicidal thoughts, absence of apathy, but not necessarily absence of PTSS, PTSD, DTD or for instance dissociative disorders. We argue that one can adapt to/learn to function with and despite eventual disorders and trauma-related symptoms. Ability to come to terms with a past, where one was both at the enforcing and receiving end of atrocities, through meaning or sense-making processes, decision-makings and navigation towards resources, which enable informants to live sustainable lives and continue the demobilization, which were initiated at escape or rescue from the Lord’s Resistance Army. This ability, like #2, 3 and 5, can be seen as operating on a continuum, but in this criteria #4 the continuum refers to having obtained more or less acceptance of one’s past. One is not completely stuck in the past, but has an overall understanding, that the past belongs in the past and that now is something different. Due to the cumulative traumatic events the majority of the population in Acholiland has experienced, flash backs might occur (as they did to the majority of informants). This can seem as us being self-contradictory: Criteria # 4 stresses that one has an overall understanding that the past belongs in the past, since flashbacks is a distortion of the notion that past and present are separate time entities. However, referring to criteria 3, we would again argue that alterations in memory due to traumatization is a different matter than appraisals and meaning making of one’s past and how ones past affects one’s present and future. Even if suffering from flashbacks, one can maintain functioning on various levels and might be able to establish constructive and healthy notions of one’s identity, even if this notion has to draw on imagination or altered beliefs in order to enable identifying with an identity that is bearable. To live relatively peaceful in co-existence with family and wider home community (occasions of domestic violence between men and women, as well as village fights between the men in the community especially in combination with the consumption of alcohol is very frequent in many areas of Northern Uganda, and in this Acholi context should not be seen as something extraordinary, but rather “a given” (conversations with numerous families, men as well as women and NGO´s in Acholiland).
This last criteria in between the lines holds a premise that demobilizing is considered constructive and resilient, and in addition “a morally acknowledgeable thing to do”. However this is complex. The vast majority of male former child soldiers and ex-combatants whom took part in this study say they would remobilize if “things got worst”; that is if war should break out again, if their life was threatened, or simply if poverty and unemployment got too detrimental to maintain daily functioning and, when being the caretaker of a family, to ensure survival of children and wife. Thus remobilization cannot always be considered “a choice to join violent networks because one seeks the violence, revenge or one has an urge to act violently, is radical etc”. Though very critical of the government, most informants would join the government army if war should break out again, because they consider it to be “the winning side”. This points to the fact that survival is not taken for granted, but has been chronically threatened in Acholiland. It is to all of us, but the threat to survival is kept very much alive in the history as well as in the minds and the present day life of many Acholi people. Thus, using Zimbardo´s words “What is available, dominates what is right and just” from studies in social psychology [19] as well as theories from evolutionary psychology [20, 21]: Most of us would choose to harm, and ultimately kill others, in order to ensure the survival of our own community. If joining combat was the only way to save our children, how many of us would pick up the gun and start shooting at the enemy literally attacking our daughters and sons? This is what has been at stake for many Acholis. Now that the war is over, to some informants, boredom, lack of belonging and lack of a sustainable future ensure (re)mobilization into the ranks. To a final few it is addiction to violence and an urge to kill that would make them take up arms again. Our data consists of stories on how this addiction came about as well as stories of how one managed through remarkable courage, perseverance, creativity and resilience to lose his addiction to killing. With the above mentioning of alterations and imagination we go on to define dissociation and shortly present the empirical basis for why dissociation is part of strategies enabling resilient coping.
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Defining “dissociation” 1.1
Defining “dissociation” from within psychiatry and psychology
In the data from Acholiland “escape” is synonymous for various terms describing mental processes of coping; “dissociation” being the most important one. Dissociation is a term or concept often described in psychology, psychiatry and anthropology. However the various fields define dissociation in very different ways: In the American Diagnostic and Statistical Manual of Mental Disorders (DSM 4), dissociation is defined as: “Disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. Among the most commonly described dissociative experiences are `depersonalization´ (an altered perception of self) and `derealization´ (an altered perception of ones surroundings).” [22, p. 649].
1.2
Dissociation in psycho-analysis: Into the `crypt´.
Rosenblum, inspired by Torok (1968) and French avantgarde author Perec writes about “The crypt”: A space where that, which is too painful to live with, is hidden away, concealed, confined. The detrimental risk of opening the crypt, which is the premise on which psychoanalysis and other, more recently developed methods of therapy such as for instance Narrative Exposure Therapy rest, is what Rosenblum reflects on in “Postponing Trauma: The Dangers of Telling”: “Perec feels that crypts obey a binary logic; they allow one modification and one only. They hold or they break. Crypts immobilize the dynamics of the unconscious” [23, p. 1333]. Perec’s and Rosenblum’s words resonate with numerous writings on reactions to trauma and how repression, dissociation and splitting are ways of coping with what are experiences of extreme suffering or shock: “Not only do traumatized subjects succeed in distancing, denying, erasing the shock, but what is erased is sometimes much more than the affective experience or subjective recognition that an unbearable event took place. Sometimes what is erased is the traumatic event itself and together with it, whole segments of reality.” [23, ibid]. When defined from within fields of psychiatry and psychology, dissociation is a common response to double bind situations, trauma and other situations of severe stress [24, 25, 22] – a link which was first made in writings by Freud and in other theories of hysteria [24, 25]. In the double bind theory by Bateson and colleagues [28], and in additional writings [29, 30] the word `escape´ is often used synonymously with dissociation [23, 22, 26]. Bateson and colleagues wrote about the challenges of being in a double bind situation: “but in an impossible situation it is better to shift and become somebody else, or shift and insist that he is somewhere else. Then the double bind cannot work on the victim, because it isn´t he and besides he is in a different place.” [28 p. 210]. The events leading to dissociation, whether singular and immediate or chronic are closely related to the building of the crypt, described by Rosenblum. The dissociation is the escape response to what is too painful to be fully conscious of; hence the building of the crypt. We shall return to both terms in the analyses. In summary “dissociation” is both used as a term to describe immediate reactions to severe, and or shocking stressful events in the actual moment of the stressor occurring, and thus as a natural human reaction to severe stress, shock or trauma. And dissociation refers to a symptom of re-occurring or chronic patterns of alterations of consciousness, memory, identity or perception of environment and self, related to past trauma now reoccurring because the stressful event/shock or trauma has resulted in traumatization, and thus what in psychology and psychiatry is often referred to as trauma – and/or dissociation disorders.
1.3
Dissociation in anthropology
Contemporary anthropological analyses of dissociation, often referred to as trance, spirit possession and as processes, which are part of rituals, tend to “concentrate on its function as a way of articulating certain selfstates in a manner that resonates with local cultural notions of personhood” [27, p. 42]. Thus anthropological approaches to describing dissociation tend to do so emphasizing meaning and structure by focusing on how dissociation contributes to the cultural constructions of self and personhood, and how dissociative processes articulate, confirm, break away from or maintain personal, social and moral order within the local cosmology. Thus, dissociation when described with an anthropological perspective seems to be expected, culturally appropriate, desired, even joyful and promoting good health. In contrast dissociation within the field of psychiatry and psychology might be described as expected in the sense that it is a mechanism; i.e. a bio-physiological response to a traumatic event, but culturally inappropriate, promoting ill health, viewed as a state of pathology.
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1.4
Emic notions of dissociation in Acholiland: `Cen´ and `Ajiji´
A majority of ex-combatants mentioned spirit possession, or more specifically, cen when sharing their stories. In Acholiland cen is defined as “the vengeful spirit of a dead person” a spirit capable of possessing places where killings have been carried out, or anyone involved with the killing, including family members to the one who has killed [31, p. 59 and notes from fieldwork]. Cen and other notions of spirits would intertwine with other explanation - or belief systems in Acholiland. The majority of Acholis I came to know during fieldwork would integrate beliefs in both ancestral spirits, Acholi ritualistic healing, witch doctors, God, prayer and pills. In the Acholi tradition people expect certain behaviors from a person who has killed. The person might be possessed by cen and furthermore a traditional healer clarifies: “If a person has killed someone and has not told his people at home, people would begin to know it through his bad deeds for he would be filled with the heart of doing harm. Especially when cen has taken control of him, like when he is drunk, he would be filled with the heart of doing bad things and even kill.” [31, p. 61]. Cen is related to `ajiji´ meaning “the urge to kill”. Such urge was a severe challenge to two of the informants in this study. Signs of àjiji´ are nightmares, shouting, trembling, not able to think straight, and loosing strength – referred to as “strong fear” [31, p. 62-63]. The signs are thought to disappear over time without any healing processes, however it is recognized that `ajiji´ can lead to “madness” (apoya or bal pa wic). In the Acholi cosmology “madness” shows itself in “severe nightmares, `visions´ during which people vividly see what has happened in the past, overly aggressive behaviour, excessive shouting, talking about things that are not related to what is currently happening in the person´s surroundings, moving around in long an aimless walks.” [31, p. 63]. As mentioned in the beginning of this section dissociation in this paper is simply perceived as ways of coping. Thus in the remaining when the terms of “dissociation”, “repression”, ”crypt” [30], “erasure“ or “disintegration” is used, they refer to the “escape” Bateson in articles and books [26] argues is a logical response to adversity. Thus the connection “escapes as coping” emerged as a common characteristic in coping strategies in Acholiland. Now, rather than determining from which paradigm dissociation should be defined, and where on a continuum from `culturally perceived healthy reaction´ to` pathological response´ to `psychosis´ and `schizophrenia´ the dissociative states presented in this paper should be placed, we have briefly presented different perceptions of what dissociation means. This will serve as a foundation to deeper and more poignant analyses of the routes of escape two informants, Janus and Martin walk down - or rather dissociate into. The following story about Janus exemplifies how this seems to be the case.
Analysis: On the first time Janus killed Janus was ten years old, when he was abducted by the LRA. Janus had attended school, and so the LRA quickly gave him the position of attending the wounded, because he could read the labels on the medicine made accessible to the LRA in the bush by collaborators, corruption, looting and attacks. Janus has seen babies being bashed against trees, and “weak rebels” pushed off cliffs. Janus was around eleven when he killed for the first time. Janus tells very different stories of the first time he killed. In one of them he takes up the narrator voice of a fierce fighter, “shooting out the brains of the other man”, “stealing his gun”, stating: “And that was the end. I would never fear anything anymore”. His voice is deep, his intonation abrupt, his body language big and harsh. In other versions of the first time Janus killed, his voice is lower; he speaks of crying when thinking about “that man”. Of waking up, seeing the face of the man, thinking about why he killed him and reflecting on that “God says we should not kill one another”. In other stories intertwining with that of the fierce soldier, and of the one haunted by images of the man killed, Janus narrates in a way that allows him to appear a hero. In one particular conversation, documented on video, Janus, without neither the performance of a fierce soldier, nor a victim, simply says: “There were very many small children in the rebel army. So many. Small, small children. So many…” and in a rare, brief moment, Janus sits there, vulnerable and just is. His shoulders rounded, his right arm wrapped around himself. Shortly after, he breaks out of the vulnerable state of being in order to again become someone else; a someone more endurable: “That is why very many are so grateful to me. Many from the bush they see me and they say `thank you, thank you´. Because I helped A LOT of children in the army, I helped A LOT! ”. Janus himself was twelve years old, when he managed to escape the LRA. Martin is an ex-combatant in his early forties who is stuck in a limbo between longing for his past as a commander in the LRA and being haunted by the past. What complicates Martin´s present life is that his longing exceeds the haunting; Martin when we meet, regularly expresses feeling “the urge to kill”. However, Martin at the same time expresses that he wishes to be at peace in the present. Janus too lives in a limbo, running around between various identities, of which none offers him at place to rest in terms of a sense of “a self” he can accept, and pursue a sustainable future through. Janus is unemployed, separated from his family because of poverty and
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stigma and turns to wishful thinking, that some call lies, in order to identify with a bearable, desirable identity and his persistent ambition to “be more than this”.
1.1
The urge to kill
There are many things Janus and Martin have had to mentally escape from to cope due to the atrocities which have been committed against and by them. One is the guilt that accompanies killing - or is considered as supposed to accompany killing. Martin has partly succeeded in this great escape. Only in nightmares do the faces of the ones he has killed, tortured and the bodies he has desecrated come to haunt him. About killings and rapes he has committed during his time as an, according to himself, highly valued and skilled LRA commander, he says: “Back then it was good”. Whether Martin never felt guilt, or whether he has had to erase it in order to function today, is not clear (more thorough analyses of this theme is in progress in a forthcoming article on coping strategies). Martin describes his experience without any traces of emotion, describes it as thinking (not feeling) ”If this is work, let it be work”. To this day, Martin says, what he misses the most about being with the LRA “is killing” and he elaborates without any encouragement: “Seeing blood makes me feel so strong, makes me feel such a strong moral. Makes me want to go and kill even more”. On scales developed far from the battlefields Martin fought, Martin has the highest score possible on “The Appetitive aggression Scale” (AAS) [6]. The scale is a measurement tool based on research in contexts of mass-violence, where psychologists found that the form of aggression described as part of combat testimonies from 2. World War, The Congo, The Genocide in Rwanda and in Northern Uganda, differed from other descriptions of aggression theory and aggression studies in the field. According to the researchers “Appetitive aggression” is defined as: “… the perpetration of violence and/or the infliction of harm on a victim for the purpose of experiencing violence-related enjoyment.” [32, p.24-25].
1.2
Appetitive aggression – a protective factor?
Martin describes how he would be on the lookout for the opportunity to be violent, if battles for some reason had not been fought for a few days in the bush. He explains how the urge to kill calls him. He says about rape and killing that “back then it was good”. But he also says: “If my wife knew what I did in the bush, she would leave me.” Martin knows that in the present life what he did can be viewed as “not good”. Martin says; “one has to consider oneself a hero – otherwise there will be a problem. If you do not see yourself as a hero, you will be the one who is dead.” Martin survived. He considers himself a hero, a good soldier. His statements of violence being “not good”, is not just pure obliged rhetoric, but speaks of a desire to find peace in the present by continuing to live with his wife and children in the quiet village. Weisterstall and colleagues argue that appetitive aggression seems to have a protective role against trauma-related illness. They have shown in studies among Rwandan genocide perpetrators and Ugandan Child Soldiers that “those who reported a greater propensity to appetitive aggression were more resilient towards the development of PTSD” [32, p. 2, 33]. All the men and women I spoke to in the village where Martin lives had been screened for PTSD by an international NGO working in the area together with locally trained counselors, and results were that the persons screened did not suffer from PTSD. Emotionally charging reactions in general, in Martins case, were somehow ungraspable, because they were rarely displayed. All informants spoke about their time in the bush as a time to completely repress (they would use the word `erase´ or `forget´) their emotions of for instance longing for home, grieving over the loss of loved ones, or feeling devastated after being forced to kill. This was a strategy of survival displayed empirically throughout every story shared in fieldwork, as well as the repression of emotions as a coping strategy when facing and coping with severe trauma is richly described empirically and theoretically across paradigmatic preferences in psychology and psychiatry [31, 29, 34]. We have just used the terms “coping strategy” and “survival strategy” interchangeably although well aware of the fact that they are theoretically two separate entities. In Acholiland however, when with the LRA, the ability to repress emotions was at that time a necessary strategy: Completely distancing oneself, separating oneself, or dissociating oneself from the pain, disgust, fear or sad emotions one feels is as effective as it is necessary if one is to survive in the bush: In addition to the daily death threats and witnessing of killings, which were part of bush life, there is a strong tendency among ex-combatants to believe that commanders in general in the LRA, and the LRA leader Joseph Kony in particular, have mythical or spiritual powers. Thus we argue that what initially was a survival strategy during war, captivation and combat, has been carried into the present as a coping strategy: “They literally know how to read your thoughts, so you just have to stop thinking about home. The first week, you think about home. But the second week… No… they can read your mind. So it is like that. Yah.” (Janus about his first weeks into the abduction).
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Concluding reflections: Escape, erasure, survival Most of the men and women we met during this fieldwork were children or adolescents when they were abducted. During the abduction incident or the shortly following initiation rituals, other abductees, sometimes including loved ones, were tortured, and often killed. Each and every one we spent time with during both fieldworks had been told to “not show sad emotions” in the bush”. “To not look miserable, to not cry”, “to not long for home” – or they would be killed, severely tortured, or forced to kill. Such a context, we argue, calls for careful conceptualizations of what resilience is and how one can or is forced to act in order to survive and/or to cope resiliently with severe, cumulative and chronic adversity of different kinds. We have made an empirically driven exploration of resilience by looking at coping strategies as they emerged during observations of actions and as they were narrated and reflected on during fieldwork. We have fused our analysis by eclecticism across disciplines to show how coping strategies during the years where the war ravaged the Acholiland were equivalent to survival strategies, and, to some extent, still are.
1.1
Forced resilience
In contexts of severe, threatening adversity, which we argue, is not isolated to Acholiland, but can include various contexts, resilience does not necessarily relate to choice, choosing one’s strategy etc. In some cases, and intense moments, we argue, the term best describing what resilience is when displayed in such a specific situation is “forced resilience”. Like Janus explained, thoughts about home were soon avoided, completely repressed or abandoned, and so were the showing of emotions or sad thoughts, because the commanders of the LRA are believed to be “mind readers” – and because experience in the bush quickly taught Janus and his many fellow child soldiers and ex-combatants, that showing signs of weakness; showing any kind of emotions considered relating to vulnerability, would get you killed. “Avoidance” within the field of psychology and psychiatry is defined as a symptom of Posttraumatic Stress Disorder. However, in Acholiland the ability to avoid certain thoughts and emotional reactions to the extent where emotions are disintegrated from subjective experience; e.g. the ability to stop thinking about home, seem to have been carried through to today as a present coping strategy. It is beyond doubt that many of the ex-combatants we spoke to were traumatized to some extent. But what forced them to abandon thoughts about home and emotions of sadness and suffering in the bush, referred to in this paper as dissociation, repression, and avoidance/escape, seems to be working as an effective coping strategy in most cases in this study. This ability offers escape where there is none, and a way to move forward by moving away from the severely violent domination that many Acholis have suffered, which creates intrusive memories, stuckness and confinement in Acholiland on a collective as well as on an individual level.
1.2
Silence intensifies when coming home
The silence which seems to so naturally accompany avoidance intensified once the former child soldiers and ex-combatants in our study came home from the bush. In the bush silence was enforced as a necessary survival strategy. But once reaching home, stories of what happened in the LRA might very well be stories of killing, torture and abduction that sons, husbands and daughters often do not wish to burden their siblings, parents or partners with. And quite possibly so the telling of the stories of killing, torture and abduction are likely to shatter the fragile post-war rebuilding of a community equilibrium, because sons, daughters, cousins and husbands are still missing, or are dead – because the perpetrators of these atrocities in many cases are the very same persons, whom are now returning after their own abduction and share of various forms of hardships while in the bush. Silence bandages help keeping together the ties of the wounded in many villages in Acholiland, as well as silence and avoidance with Rosenblum’s words serve as bandages holding together the crypt on an individual level too; keeping it from breaking and Janus from staying too long in vulnerable states and identities undesirable, or unbearable, to him – and his home community. Not so few grew up in the bush, made friends, new families, grew through the ranks in the LRA, and into a sense of belonging. Very few of them shared stories of experiencing growing fond of killing, but some did. Whatever balance between being traumatized or thrilled by the battlefields, silence seems the safest and more effective coping strategy to obtain communal mercy, or at least lessen the fierce stigmatization, which most often follows a homecoming. One’s pride as an LRA soldier or commander, as in the case with Martin, does not have much space, if any, in neither the local, nor the global communities [35]. There are few exceptions among the Acholis whom we followed who had returned from the LRA where silence had been replaced by sharing of stories and with openly confronting taboos of atrocities committed. 3 out of the 4 whom had shared their stories, were encouraged or told to do so while with an NGO, or when being sponsored or taken care of by one of the many European aid-workers whom have passed through Gulu town over the years. One young man, Jason, who in many ways stood out in remarkable ways and whom never passed
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through any reception centre or NGO was abducted as a 12 year old boy from his local village and quickly rose through the ranks with the LRA. A common strategy in the LRA is to send soldiers, often child soldiers, back to their local villages to loot, abduct and in some cases cause terror by committing very graphic torture and killings. This also happened in Jasons case. Jason decided to abandon his post as a commander in the LRA and upon homecoming, one of the first things he did was to walk up to the family, from where he abducted three boys while with the LRA - two of them still missing - to let them know he was the abductor and ask for forgiveness. The family responded that they had known Jason as a child, that they knew him as a “good and gentle boy”, and that they would forgive him. Further unfolding of Jason’s story must resume elsewhere, but this is the only story we have heard of where silence at a returnees own initiative turned into sharing and confrontation of taboos during 2006 and 2012/2013 fieldwork periods. This study, of course, points to the differentiation between whom one is supposed to silence ones past to, and where exceptions to this collective rule are allowed or encouraged. As a few among many European researchers and NGO workers visiting before us, we were safe to share stories with, because we did not have sons or daughters, or other relatives whom the informants could have abducted, tortured or killed during their own years of abduction/or years with the LRA. In the urban areas talking to “wazungus” like us, could potentially be beneficial in terms of material resources, however in this case it was made clear that this would not be the case. Lacking in our material is data on bodily reactions; remnants of memories, which we would in some cases with female former child soldiers, inquire gently about, but would not get verbal accounts of, although body language too is indeed informative in its own right. The stories shared by female former child soldiers and their coping with pasts of repeated rape and violence support the strategies of dissociation, avoidance and silence, which we conclude are the most prevalent coping strategies in our data. In this paper however we have chosen primarily to focus on two male informants, and will elaborate on the female former child soldiers elsewhere. The mental escapes into something better than what the past, present or future has to offer the two men, are in both Martin and Janus’ case mostly walked alone. The atrocities of the past are silenced, due to taboo and fierce stigmatization in the local community due the intertribal character of the conflict in Acholiland. However stigmatized or lonely, Martin and Janus do share a collective response carried out by many Acholis: Silencing and being silenced in order to avoid a horrific past to take up too much space, in order to obtain a sense of control, and thus leaving a more endurable image of the future in Acholiland. The outro is not rosy-red. Janus is hungry, literally and existentially, and Martin says the only reason he does not return to violence, to killing, is that he does not have a gun. Is there a limit to how long one can endure stuckness without reacting in ways that are destructive to self and/or other? History nods. Martin and Janus have both lost lives of loved ones and taken lives. They have argued (Martin consistently, Janus only when taking up the position of fierce soldier), that doing the latter was right. To provide a rich account and exhaustive reflections on what place moral has in the Acholi context is beyond the scope of this paper. Deutch [36] seems to be even more at point than Zimbardo when trying to explain why gross human rights violations at times are believed to be the right thing to do: “Once a boundary between `us´ and `them´ has been established, and `them´ are gradually excluded from the moral community, one can consider oneself moral for engaging in otherwise `depraved´ actions” [36. P. 24]. Going along with Deutch´s thoughts on inclusion and exclusion: A judgment is present when creating the ultimate exclusion; a killing. And a judgment is present in the creating of the crypt, and when going into shock while experiencing trauma because it necessitates a subliminal and/or cognitive appraisal in the form of the judgment of something being too painful to fully and openly embrace in its totality. Many would have broken down, many would and do appear in studies on the prevalence of PTSD, DTD or other disorders from the Acholi region [37, 38, 39, 40]. Many others merge into new constellations of militias or private security markets [41, 42], cadreship [43] or strike up fights in the many loud bars and liqueur sheds around Gulu town. The borrowed terms from psychiatry and psychology can categorize Janus as suffering from PTSS and split personality disorder, and Martin as one that is placed so far out on the continuum of dissociation and on the scale of appetitive aggression that it serves him as a protective factor against the breaking of the crypt, at the brink of who knows what? Time will tell what will become available to Martin and Janus. For now, coping strategies of dissociation, avoidance, silence and compartmentalization allow some to be heroes and to maintain the hope of one day to become “more than this”.
1.3
The situated constructive-destructive continuum
The last point to end the concluding reflections is that before trauma or adversity related mental illnesses progress so far out on the continuum we will call `the situated constructive-destructive continuum´ that it does belong within a category of pathology, there once was and might still be a meaningful response in the behaviour, which was at the time necessary and helpful because one had to deal with adversity or even immediate and life-threatening danger. We call it the situated constructive-destructive continuum rather than the `normal-abnormal´, `normaldeviant´, or `normal-pathology´ continuum most often operationalized within diagnostic disciplines, because we
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hold onto our initial argument, that in a context like Northern Uganda, and other war torn contexts or dysfunctional families where traumatic events are cumulative and crisis become chronic, adaptation processes take place too. Resilience and traumatology research is very familiar with and attentive towards adaption and how influential adaptation is to coping, resilience and thus dealing with or overcoming adversity and trauma. We however, like Bonanno and Barber, request more studies focusing on the myriad of, individual differences in, and detailed accounts of coping with/responses to adversity, PTE´s and/or trauma whether cumulative/chronic or single/acute. For example a study exploring resilience among Palestinians in the Ghaza strip, or child soldiers in Northern Uganda in combination with assessing resilience using the validated scales will, we argue, benefit from adding to their study questions about what meaning making processes (or lack thereof – see [44]) exist on the ground about how to overcome trauma, what notions of victimhood exist in the specific context and culture, and; when a trauma is collective and embedded in decades and possibly centuries of a community´s or nations history, how does this possibly influence such measures? To be specific one could ask what happens, when atrocities become norm? Is the one committing the atrocity and the one whom the atrocity is committed against still related to feelings of shame, shaming or taboos? Is the reaction as severe? We are not asking these questions to diminish the destructiveness one who has killed has carried out, nor the suffering this has inflicted on the dead and his or her relatives, whom have lost a loved one. But in the pursuit of understanding coping strategies and resilience and how these are affected by the kind of social fabric, history, structure, rituals and culturally influenced expectations to “how one/we are supposed or can react to suffering in this particular context” we argue that when atrocities and trauma become collective as well as cumulative, in the case of Acholiland less attention, less “right to mourning”, and less time and energy was spent on “feeling” the suffering. Less blame was put on killing. Because the circumstances were in some areas and villages that the majority of young men had killed some even killed kin - and the majority of young women - girls even - had been raped. Majority matters, because what is the norm matters. This matters because it seems universally human to compare oneself to ones surroundings and to want to feel a sense of belonging, a sense of fitting in. Several experiments in social psychology and neuropsychology has shown that conformity is a powerful structuralizing principle [19]. Atrocities hurt. But if you are the only one experiencing this, it becomes more of a taboo than if there is a shared understanding; a knowledge of that “this happened to us” - even if this knowledge is silenced.
1.4
The absence of the word “victim” – and of “victimhood”
An important note is that interestingly the word “victim” or “victimhood” [45], does not exist in the Acholi language, nor does a synonym. This stands in great opposition to the discourses, campaigns and interventions carried out by many of the numerous NGOs, which travelled to Northern Uganda to provide aid, and psycho-social interventions to help the Acholi population in the years where the war took its greatest tolls. The lack of the word “victim” in the Acholi language - and the fact that none of the female and male former child soldiers, and/or ex-combatants whom shared their stories identified with a victim-position - stands in strong opposition to reports and psychology and psychiatry research articles published from the region [46, 47, 37, 38, 39, 40]. NGO and human rights based discourses, practices and articles stressing the importance of “claiming the right to victimhood” or “speaking through your trauma in order to be able to heal” is in most cases full of good intentions, sometimes based on evidence [48, 49] when arguing that this is the most constructive trajectory to healing, but not necessarily taking into account the individual, socio-cultural and historical influences marking a specific context. For the children, women and men this study encountered, knowing what is your right seems crucial. But if the resources are not there to ensure that rights are fulfilled - if, for various reasons, the system, the financial resources and the human resources it takes to inform about, advocate for and make sure rights are given, met and followed are not obtainable, one can feel even more powerless by having learned about that “everyone has the right to…” not go through, what the vast majority of the Acholi population and many more around the globe unfortunately have had to endure for years.
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Weisterstall, R., Huth, S. Knecht, J., Nandi, C. & Elbert, T. (2012): Appetitive Aggression as a resilience factor against trauma disorders: Appetitive Aggression and PTSD in German II World War Veterans. PLoS ONE 7 (12). Elbert, T., Weierstall, R., Schauer, M. (2010): Fascination Violence: On mind and brain of man hunters. Eur. Arch. Psychiatry Clin Neuroscience 260 (Suppl. 2) 100-105. Springer. Montgomery, E. Krogh, Y., Jacobsen, A. Lukman, B. (1992): Children of Torture Victims: Reactions and Coping. Child Abuse and Neglect. Vol. 16, p. 797-805. Lanken, C. (2012) Truths out of place: homecoming, intervention, and story-making in war-torn northern Uganda. Childrens Geographies, 10:4, 441-455.Routledge. Deutsch, M. (1990). Psychological Roots of Moral Exclusion. Journal of Social Issues, 46, 21-25. Klasen, Gehrke, Metzner et al (2013) Complex Trauma Symptoms in Former Ugandan Child Soldiers. Journal of Aggression, maltreatment and trauma. 22:7, p. 685-697 Betancourt, T., Speelman, L., Onyango, G. Bolton, P. (2009) A Qualitative Study of Mental Health Problems among children Displaced by War in Northern Uganda. Transcultural Psychiatry, Vol. 46 (2):238-256 Okello, J., Onen, T.S. & Musisi, S. (2007) Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda. African Journal of psychiatry, 10, 225-231 Pham, P., Vinck, P, Stover, E. (2009) Returning home: Forced conscription, reintegration, and mental health status of former abductees of the Lord Resistance Army in northern Uganda. BMC Psychiatry, 2009, 9:23 International review of psychiatry, Vol. 20, Number 3, p. 317-328 Christensen, M. M. (2013): Shadow Soldiering. Department of Anthropology, Copenhagen University. Wessells, M. (2006) Child soldiers: From violence to prevention. Harvard University Press Cambridge, MA, U. S. Lanken, C. 2013: Guns and Tricks. PhD thesis (in press) Department of Antropology. Copenhagen University. Bonanno, G. A. (2013). Meaning making, adversity, and regulatory flexibility. Memory, 21, 150-156. Jensen & Rønsbo (eds) (forthcoming): Histories of Victimhood. Book. Penn University Press. Human Rights Watch (2013) World Report. Uganda Human Rights Watch (2005) Uprooted and Forgotten. Impunity and Human Rights Abuses in Northern Uganda Robjant, K. Fazel, M. (2010) The emerging evidence for Narrative Exposure Therapy: A review. Clinical Psychology Review. 30 (8), p. 1030-1039. Schauer, M. Neuner, F. Elbert, T (2011) Narrative Exposure Therapy: A short term treatment for traumatic stress disorders. 2nd and extended edition. Hogrefe Publishing.
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Resilience and segregation on post-communist romanian labour market Istrate M., Bănică A. 1
Alexandru Ioan Cuza University Iasi, Faculty of Geography and Geology, Geography Department (Romania)
[email protected],
[email protected]
Abstract During the last two decades Romania has experienced major social and economic changes, influencing the structure and dynamics of the labour market: decreasing number of active and working population, increasing unemployment, the growing risk poverty and rising vulnerability of certain socio-professional groups. This approach studies the labour force in Romania from the perspective of the relation between resilience and segregation. The purpose is to identify regional convergences and disparities, shaped by the adaptation of the labour force in post-communist Romania, in the general context of international selective migration of population, economic crisis and recent application of new employment policies, in accordance with the European regulation. Based on the activity rate indicators and segregation indexes applied to different sectors and economic activities, the paper analysis the spatial differentiations marked by modernization processes of the social structures or by the perpetuation of the traditional regional disparities. The results demonstrate that Romania has entered a new social and economic paradigm while the issue of effective utilisation of labour force remains one of the main challenges of the future. Keywords: labour force, regional disparities, segregation index, occupational mutations, social modernisation, labour market policies.
Introduction In numerous studies dedicated to resilience in different fields (biology, psychology, engineering etc.) there are references to the capacity of a system to adapt when subject to external perturbations. Therefore, resilience expresses mainly the capacity of a system, region, community or person of responding and adapting to a quick change, of absorbing external shocks without attenuating their impact, so that sudden strains may not necessarily lead to a long-term decline, but to the fastest possible recovery [1], [2], [3]. The summarization of the characteristics of resilience in all these subjects have inspired and enriched the conceptualization on this topic, the varied approach of this term opening a wide range of interpretations, including in the field of the labour market analysis [4]. Generally, the labour market notion includes all the institutions and policies governing the labour force flows, as well as rules influencing employment, mobility, competences acquisition and continuous education, income distribution etc. The sudden changes during the past 24 years in Romania, as well as the broader structural transformations (higher flexibility, instability of jobs, changing working and salary conditions etc) are both opportunities and challenges for the labour market [5], [6]. The labour force resilience may be explained by reviewing the 4 stages characteristic to a system subject to external influences: challenge, context, response and outcome (fig. 1). Labour Market Resilience
Challenge
Context
Response
Outcome
Fig.1 : Labour market resilience – conceptual framework (After Bigos et al., 2011, pp. 19)
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First, the perturbation or initial shock triggers certain response mechanisms. For Romania, such thresholds can be identified in the sudden change of the political regime at the end of 1989, the beginning of the privatization of the large industrial enterprises in 1997 or the economic crisis in 2008. These events seriously affected the labour market by generating a decrease of both employment rate and national economic stability. The context refers to the fundamental structures that shape the labour market, namely the state politics, the functioning of the decision-making institutions, the demographic overall situation and the socio-economic context. Passing from a centrally planned economy to a transition economy and, subsequently, to a market economy (especially after 2007) implied the introduction to reforms hard to assimilate by a large part of the active population. The response should be understood as an adaptation, namely the ability of the labour force of dealing with the innovative challenges and the re-arrangement of the institutional structures. Finally, the outcome is either preservation of the initial pre-shock situation or the improvement of system’s functionality. In other words, the labour force either was deeply affected or gained by minimizing the social costs and maximizing the citizens’ welfare (decreasing the unemployment rate, changing the income distribution, improving life quality etc.). A feature that can be put in relation to labour force resilience is occupational segregation that consists in the unequal distribution of the various work posts between two groups considered to be different. If we consider gender segregation of the workforce, one should notice that it is a multidimensional process that refers to the fact that men and women work in different occupations, economic sectors and have different contractual terms.
Objectives and methodology The present approach studies the labour force in Romania from the perspective of the theoretical and methodological ensemble of resilience and segregation. Our first objective would be the estimation of the resilience of the labour force system components, the identification of the problems it faces, as well as the analysis of multiple relations contributing to the resilience of this system. Taking into account previous researches [7], [8], [9], [10] and using the available data, we built a composite index of the labour force resilience. Consequently, the capacity of the labour force to adapt to the new economic conditions was analysed based on six indicators: st_p –the relation between the active population employed in industrial and services activities reported to the population employed in the primary sector; castig – the average monthly gross salary earnings per counties; som – unemployment rate; edu_sup_act – the percentage of the highly educated population out of the total population; migr_comp – the migration compensation indicator i.e. the rate between the arrived and the departed for each year of the considered period; intrGDP – the economic performance derived from the number of active companies, gross national product, related to the country population. The TEMPO chronologic data series (1990-2012) from the National Institute of Statistics [11] was used in order to calculate the average value (med) and the average annual growth rhythm (rtm). The data were standardized, normalized and used within an ascendant hierarchic classification (cluster) in order to obtain typologies regarding the status and degree of adaptability of the labour force in every county. The same variables were integrated within a principal component analysis (PCA) able to reveal the different importance of each indicator and the relative weight within the final resilience index. The second objective was the identification of the existence of segregation per genders and activity sectors of the employed population and the estimation of segregation as regards the income distribution. We calculated an index of gender dissimilarity (ID) [12 ] of the employed population of each county, in relation to the active population. Eventually, a correlation between the resilience index and the dissimilarity index assessed the extent to which a higher degree of adaptability of the labour force is explained by the equal participation of women and men in economic activities.
Results 1.1
Evaluating workforce resilience
The recent major perturbations in the labour force system were determined first of all by the change of the political and economic system at the end of 1989, followed by a series of events that accelerated the system dynamics: the privatization and the deindustrialization of Romania (the shut-down of the great industrial units) which generated an important mass of officially unemployed persons but also unemployment under the mask of anticipated retirements, the restitution of agricultural properties, the migration of the labour force to Western Europe (especially after 2001), the accession of Romania to the European Union and the necessity of aligning to the European policies (including the labour force policy), and last but not least the world economic crisis (starting from 2008).
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The ‘90s were marked by a continuous decrease of employees and an explosive increase in the unemployment rate. The climax was reached between 1998 and 2000, when the number of unemployed persons exceeded 1 million persons. Due to the limited possibilities of employment, part of the labour force left the labour market, another part was oriented towards agriculture and another towards the black labour market. From 2000, the phenomenon started to decline and was reactivated after the emergence of the economic crisis in 2008, when a new increase in the unemployment rate was reported. If one refers to the adaptation cycle [13], the labour force system is currently passing through a reorganization phase marked by its resizing, the reduction of the secondary sector and diversification of the tertiary activities. According to the theoretic ensemble of resilience, this phase is characterized by the emergence opportunities that could easily reform the system, either by interventions from the upper hierarchic levels or by accumulating changes from the lower levels [14]. Nevertheless, future malfunctions might occur, given that the age-related structure of the population is more and more unbalanced, and the employees-retiring people ratio is clearly to the disadvantage of the first category. At the same time, the increasing vulnerability of certain segments of the active population (young men, unemployed, people with a low level of education etc.) highlights the importance of the horizontal and vertical relations between components while the political and legislative incoherence and instability diminish the resilience of the labour force.
1.2
Resilience assessment at county level. Cluster analysis
Based on these assumptions and taking into account the afore mentioned indicators, we applied a cluster analysis (ascendant hierarchic classification) and identified five classes that express the differentiated evolution of the labour force and its more or less resilient character in Romania, at county level (fig. 2).
Fig. 2 Workforce resilience- typology at county level
Class 1 includes counties (Alba, Gorj, Argeș, Prahova) characterised by strong industrialization during the communist period, which managed to a certain extent to maintain their activities in the secondary sector; after 1989 they went through critical moments, marked by a high unemployment rate and high emigration rate, but, currently the tendencies seem positive, especially through the consolidation of their tertiary profile; Class 2 is the most resilient; it includes counties economically strong, which had a quick recovery after 1990, benefiting from important re-technologizing investments, tightly connected to their favourable geographic position, to the superior infrastructure or long tradition of industrial development (Cluj, Constanța, Brașov etc.). Class 3 is the most comprehensive, occupying large areas east or south-east, but also in the Carpathian domain (Suceava, Botoșani, Buzău, Teleorman, Olt, Sălaj ș.a.); it includes counties with an important agricultural and natural potential, but with a relatively low degree of urbanization and modernization; though
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they have been identified for a long time as areas of emigration of the labour force par excellence, their current counterurbanization and growth of the productivity in the agricultural activities seem to maintain a certain stability. Class 4 includes counties (Galați, Bacău, Hunedoara etc.) that are currently in the phase of reorganization, namely of replacing an unprofitable industrial activity implanted in the communist period with more competitive fields. Their “inherited” professional structure, as regards the qualification level, is an advantage for economic restructuration and modernisation. Class 5 has a profile close to the national average, includes apparently unbalanced counties, either because of the weak subordination of the rural space to one major city (Iaşi, Oradea), either due to the lack of such an important nucleus that may polarize efficiently the surrounding areas (Covasna); they are contrasting counties, where the adaptation and modernization of a part of the labour force coexist with the resistance to change of another part.
1.3
Segregation assessment
We have analysed both horizontal segregation, dividing females and males workers per activity sectors (primary, secondary, tertiary), and vertical segregation, dividing employees according to the income level [15]. If we take into account horizontal segregation in 2012, women predominate within the population occupied in social services (education 69%, healthcare and social work 79%, administration 57.5% ), activities much more stable than the industry or private services [16], [17]. Nevertheless the issue of reduced access of women to the leading functions and the smaller earnings of women compared to men remain current. Employed men predominated in all the other economic activities, holding overwhelming proportions in transportation and storing activities (84.4%), construction works (84.1%) and extractive industry (83.3%). While the first ten years after the revolution were characterized by economic instability, strongly influenced by the level and evolution of inflation, the second decade was marked by the end of the period of transition to the market economy, a positive evolution being reported in all the economic branches except for agriculture, revived only after 2007. From the viewpoint of the gender-related segregation, certain activities stand out due to a higher degree of feminization (healthcare, education, administration). As regards the agricultural and processing industry sector, segregation is much lower, on the background of a much more turbulent evolution of these activities (Table 1). Table 1: Share of women in same major sectors of activity and their dynamics (Source : National Institute of Statistics in Romania, TEMPO Database, Accessed in January 2014)
The income-related segregation can be explained by a gender-related segregation between activity sectors, professions, jobs and hierarchic positions. Even if the salary gap between women and men is rather small and decreasing in the last years, men are better anchored in extra-family activities and consider their job more important, in exchange women are more traditionalistic and more attached to the household. The concentration of women mainly on certain activity sectors determines a decrease in their salaries (crowding effect). During the analysed period, the average gross salary of men was constantly higher than the national average, reaching its maximum value in 2001 (9.3% higher than the national average), but this percentage has been slightly decreasing for the past years. Nevertheless the average gross salary earned by women had an ascendant evolution, reaching 89.2% in 2001 and approximately 96% in 2008, after which it went back to 93%. As regards the distribution of employees into salary categories, the gender-related segregation is more than obvious [18]. Women hold a high percentage in the categories of very low salaries (under RON 670). In the average salary group (up to RON 4,000), the gender-related distribution of employees is more homogeneous, but in the category of high and very high salaries, the percentage of men is much higher. Therefore, the differences in qualification level, job and hierarchic position influence the income level for the men and women working in different activities of the national economy.
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1.4
The relation between resilience and segregation of workforce
If we take into account the correlation of the resilience index previously obtained and of the genderrelated segregation degree on the labour market (described above and calculated as dissimilarity index for all Romanian counties), we notice a firm connection between the two. Each of them has a different basis: resilience is grounded on a set of factors seen from the point of view of their evolution, while segregation is centred only on the presence of the active population corresponding to the two genders on the labour market. However, a strong segregation, namely a much higher employment rate in men in comparison to women reveals a traditionalistic, sometimes retrograde, behaviour, which may be interpreted as a weak adaptation of the labour force to current realities (fig. 3). 6 y = -0.1932x - 1E-17 R² = 0.2332
5 4 3 2 1 0 -6
-4
-2
0
2
4
6
8
-1 -2
(a)
(b)
Fig. 3 (a) Correlation between resilience and dissimilarity indexes. (b) The highest values for regression’s residuals
The tightest relation between gender-related segregation of the employed and the recent efforts of restructuring the socioeconomic system under the need for adaptation to the requirements of the market economy is most visible in the counties Alba, Satu Mare, Mureş, Bacău, Iaşi, as well as Hunedoara, Mehedinţi and Dolj. Still, there are administrative units whose clearly superior economic performance has different explanations, less connected to the gender-related structure of the labour force. This is the case of the capital and Ilfov, as well as counties Timiş, Braşov, Cluj, Sibiu, Arad and Constanţa. On the other hand, there are counties whose labour force is mostly exodynamic and apparently less adapted to the requirements of the inner market (although many times these are counties where a large part of the activities is insufficiently transparent or taxed), but where the gender-related segregation index is low. A particular case is Vaslui County, where though the lowest percentage of women in the employed population destabilizes the professional structure, it is not translated by a complete lack of capacity of resilience of the labour force.
Conclusions The analysis of resilience within the workforce system highlights that recent social-economic were unequally resented by different areas in Romania, a fact that was reflected by the employment rate in dynamic economic sectors, the unemployment ratio or the level of salary earnings. The adaptation capacity is in direct relation to the quality of human capital and to the capacity of economic agents to innovate and increase their performance, both contributing to the attractiveness of each region or county. The composed workforce resilience index at county level is well correlated with the gender segregation of the occupied population which shows that increasing the integration of women in certain economic sectors is a mark for the capacity of territorial systems to adapt to the modern society’s requirements.
References [1] [2] [3]
Hill, E.W., Wial, H., Wolman, H (2008). Exploring Regional Economic Resilience4. Institute of Urban and Regional Development, University of California, pp. 3-6 Pike, A., Dawley, S., Tomaney, J. (2010), Cambridge Journal of Regions, Economy and Society, 3, 59 – 70 Fingleton, B., Garretsen, H., Martin, R. (2012). Recessionary shocks and regional employment: evidence of the resilience of U.K. regions. Journal of Regional Science, vol. 52, no. 1, pp. 109-133
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[4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18]
Bigos, M. et al. (2013). Review essay on labour market resilience, INSPIRES Enache, S. (2013). Interdependența dintre piața muncii și șomaj în economia postcriză. Economie teoretică și aplicată, vol. XX, no. 8 (%*%), pp. 92 – 101 Dimian, G.C. (2012). Impactul dezechilibrelor de pe piaţa muncii asupra decalajelor regionale în contextul economic postcriză. Economie teoretică și aplicată, vol. 19, nr. 9, pp. 25-35 Briguglio, L. et al. (2008). Conceptualizing and measuring economic resilience Christopherson, S., Michie, J., Tyler, P. (2010). Regional resilience: theoretical and empirical perspectives, Cambridge Journal of Regions, Economy and Society, 3, pp. 3 – 10 Hamdouch, A., Depret, H. B., Tanguy, C. (2012), Mondialisation et resilience des territoires, Presses de l’ Universite du Quebec Stokols, D., Lejano, R.P., Hipp, J (2013). Enhancing the Resilience of Human – Environment Systems: a Social Ecological Perspective, Ecology and Society, 18 *** Institutul Național de Statistică, baza de date tempo-on-line ***(2009), Gender Segregation in the labour market, European Commission s Expert Group on Gender and Eployment (EGGE) Chapple, K., Lester, T.W. (2010). The resilient regional labour market? The US case, Cambridge Journal of Regions, Economy and Society, 3, pp. 85 – 104 Drăgan, M. (2011). Reziliența sistemului regional Munții Apuseni, rezumatul tezei de doctorat, Universitatea Babeș - Bolyai, Cluj – Napoca Dobre, M.H. (2011). Efectul de evicțiune pe piața forței de muncă din România. Economie teoretică și aplicată, vol. 18, nr. 1, pp. 192-200 ***(2011), Balanţa forţei de muncă la 1 ianuarie 2011 [Labour force balance in 1st of January 2011], Institutul Naţional de Statistică, Bucureşti ***(2013), Balanţa forţei de muncă la 1 ianuarie 2013 [Labour force balance in 1st of January 2013], Institutul Naţional de Statistică, Bucureşti ***(2013), Women and men: work and life partnership, Institutul Național de Statistică, București
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Resilience in children originated from families in which parents migrate due to labor conditions Kanalas G.¹, Micu-Serbu I.B.¹, Gulyas V.¹, Ranta M.3, Nussbaum L.¹,4, Nyiredi A.²,4, Jurma A.1,4, Rozinbaum G.I.¹ 1
Louis Turcanu Children’s Emergency Hospital Timisoara – Department of Child and Adolescent Neurology and Psychiatry Timisoara (ROMANIA) ² Louis Turcanu Children’s Emergency Hospital Timisoara – Department of Pediatric Surgery Timisoara (ROMANIA) ³Ovidiu Densusianu Technological High School Calan (ROMANIA) 4 Victor Babes University of Medicine and Pharmacy Timisoara (ROMANIA)
[email protected],
[email protected],
[email protected],
[email protected],
[email protected],
[email protected],
[email protected],
[email protected]
Abstract Introduction: In the circumstances of emotional delicacy and fragility in children, family separation endangers the quality and homogeneity of its development, exposing the child to several risks. The phenomenon of migration is not new, however the contemporary provides a few characteristics that know no valences in the afore societies. Objectives: Identifying protective factors in behavior, cognitive and emotional development in children with parents working abroad due to the economical needs. Methodology: The study includes children aged 6-10 years divided into two groups. The study group is formed out of children from families in which parents, both or only one of them have migrated abroad. And, the control group formed of children with parents at home. In the area of investigating the behavior, emotional and cognitive development, we used projective techniques - drawing techniques: Tree test, Draw-a-Person test (DAP), SDQ questionnaires (The Strengths and Difficulties Questionnaires) completed by parents/caregivers to assess emotional and behavioral problems in children. Results and conclusions: The results argue for the development of resilience in the presence of several protective factors resulting from workshops within curricular and extracurricular educational activity as a counterbalance for a resilience risk factor, that of having a parent/both parents migrated. Key words: children, resilience, protective factors, risk factors, migration.
Introduction In assessing the Romanian migration phenomenon periodization was used in order to highlight changes in type, destination and intensity of this phenomenon. At the beginning of the 90s migration became a social phenomenon of great importance that crosses several phases [1,2]. Thus, if at first migration was done to reunify families; later on it was based upon labor, due to economic needs and shortly became fundamental in this respect[3,4]. Migration as a phenomenon generates unfavorable consequences both at micro- and macro-social levels. One of these consequences reflects upon family integrity, hence the de novo appearance of labels that have been ingrained in the form of “home alone generation”[5]. Parents, one or both, under economic pressure migrate abroad aiming a better life for their offsprings. In an interview conducted with one of the mothers, which after a long period of time abroad, came back home for a few days, said: “Afore, I could barely nourish him, now I can send him to school and assure a decent life”. Ritual is the very first formula for a coherent and general concept in life[6]. In the mythical world the child without is attributed several meanings, being found in various Romanian and South-Eastern stories. In one of the Romanian legends following the mother’s sacrifice, the child is approved as deity, seizing to exist as human; it is cared for by fairies, rocked by the wind and bathed by rain. The child is one, single, unique and through him/her worlds arise. He/she arises directly from the heart of the elements: water, rain, wind. The child without parents is subject of Romanian folkloric creations being attributed deity traits, and his/her tragic fate determines the later heroic vocation.
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However, in the context of the child’s emotional delicacy and fragility, family segregation threatens its evolutive traits and homogeneity, exposing him/her to various risks. Resilience research is based upon understanding the reason for which some children are more vulnerable than others when facing adverse effects of the unfavorable environment. Resilience is better revealed when approached from the developmental processes point of view. Certainly, resilience comprises and is based upon multiple and various factors: from biological to life events, cognitive factors and coping mechanisms[7]. The plurality of factors eventually leads to a resilience structure with inherent characteristics. Known, is the fact that the current social environment makes it more difficult to the parents to develop skills for stress endurance. Several terms are to be fulfilled in order to develop the ability to resiliate to stress: early attachment and parental interaction – the base for child’s morality; development of educational intimacy – that conducts to immunity in front of existential trauma; proper educational environment. Given the impact on children all over Romania of parental absence through migration, we aim to emphasize the resilience of children from Calan, a town in Hunedoara County, Romania. This town is a representative example of decreasing socio-economic levels and thus a high rate of labor migration. Thereby, within Calan several children are raised by only one parent, grandparents or an outer family caregiver, however they benefit from curricular and extracurricular programs within their schools[7].
Material and methods During its industrial activity, Calan a town located in the Hunedoara County of Romania, encountered several national and international premieres: the statute of the largest furnace in Romania (the late XIXth century), the world first industrial plant for coke and semi-coke production through fluidization, use of furnace blowers produced and designed by Romanian specialists and the manufacturing of casting machine for steelworks straight from Romanian first fusion cast iron. Currently, due to nearly complete cessation of the former industrial platform, upon which the population depended almost entirely, along with the dismissal of most employees; unemployment rates exploded, thus Calan faces serious economic and social problems. Moreover, according to the census conducted in 2011 the city population amounted 11,279 decreasing from the previous census conducted in 2002, when there were recorded 13,030 people[8,9]. Given the socio-economic problems that welcome new generations, local schools have organized various activities within the Children’s club: Drama, Children Theatre, Decorative Art, Dance, Soccer, Computer World Traveling, The Art of Behaving, Classes of English and Spanish, Personal Development and PsychoBehavioral groups for Children and Preadolescents; and trainings for parents and caregivers. Thereby, this study was conducted in Calan, Hunedoara County within two Elementary Schools under the patronage of Ovidiu Densusianu Technological High School, in between 01. 12. 2013-14. 02. 2014. There were included 50 children aged between 6-10 years. They were randomly selected from the abovementioned schools and were divided into two equal groups (N=25). The control group comprised children from wellorganized families, whereas the study group comprised children with a background of dysfunctional family. The term of dysfunctional family refers to families in which one/both parents is/are migrant/s as a result of low economic standards, thus arising the need to provide adequate financial support to the family left behind. Each of the groups includes 11 male children and 14 female children. Within the study, we applied projective techniques (the drawing technique: Tree test, Draw-a-Pearson test and the SDQ Questionnaire - The Strengths and Difficulties Questionnaires) on both parents/caregivers and their children, with the purpose of assessing the children’s cognitive, emotional and behavioral levels. These techniques were applied within an organized Creative workshop. Both parents and children were prior informed about the workshop and this study through brochures, in which the purpose, terms and form of the study were explained. Afterwards, semi-structured interviews were applied in 15 of the 50 parents that gave their consent to participate in the study. The other parents could not be present at the interview on the established dates and hours. The tests were applied by a Child and Adolescent Psychiatrist, who in a joint collaboration with the Professor – Head of the Children’s Club and the Elementary Schools’ Psychologist provided supervision within the workshop. At the end of the workshop, the material was gathered for interpretation by the Child and Adolescent Psychiatrist and a psychologist. The data thus collected was organized in a Microsoft Excel 2007 data base, comprising of the following fields: identification data (name, initials), demographics (age, gender), type of caregiver (parent, grandparent and outer family caregivers), SDQ Questionnaire (divided into – emotional symptoms, conduct problems, hyperactivity, peer problems, prosocial behavior and SDQ total), the Draw-a-Pearson test (score and interpretation) and the Tree test analysis that was divided into traits of adaptability, personality and
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environmental relations, together with general traits defined as E1, E2, E3, E4, E5. Data analysis was performed using SPSS (Statistical Package for the Social Sciences) version 17.0 and EpiInfo 7. The groups were compared using unpaired t-tests or the χ2 test. p.70). The students in psychology are placed according to the 8 factors selected like in the table below:
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Tabel 2. The resilience on students on economy: the items with best values in communalities Nr/ imp or tanc e 1
2
3 4 5
6 7 8
Question
Sometimes I push myself to do different things even I do not like it I do not loose time with things which are out of my control I like myself. Usually I explore a situation from all perspectives. For me is important to keep high interest for something. I always find something to laugh. The life has sense. I trust my self and that is why I can overpass difficult periods.
1 (total disagreeme nt) frec %
2
3
4
frec
%
frec
%
3
3
5
5
11
5
5
9
9
0 0
0 0
1 1
0
0
1 0 0
5
6
7 (total agreement)
%
frec
%
frec
%
frec
%
11
fre c 20
20
19
19
32
32
10
10
21
21
30
30
12
12
17
17
6
6
1 1
9 1
9 1
12 17
12 17
29 25
29 25
24 38
24 38
25 18
25 18
0
0
2
2
5
5
12
12
37
37
44
44
1
3
3
8
8
11
11
20
20
31
31
26
26
0 0
1 4
1 4
2 8
2 8
11 12
11 12
15 22
15 22
26 34
26 34
45 20
45 20
If we rune the average on the less resilient behaviors, we find 12% of the sample as placed in this side; double of this, 24% are proving the best resilience. However, based on the same type of calculation, if we take in consideration the agreements 73% of the students in psychology are moving on the right and resilient direction. 15% does not show any direction on the scale of resilience. The same statistical approach done on the data collected among the students in psychology, highlighted 5 factors which account for similar values as the values on psychology, regarding the communalities shared with other items. These factors are not the same as the ones found among the students in economy. In order of their communalities values, they are in the table below. Table 3: The resilience on students on psychology: the items with best values in communalities Nr/ imp or tanc e 1
2 3
4
5
Question
For me is important to keep high interest for something. If necessary, I can manage by myself. When having some projects I can successfully go to the end When I am in difficult circumstances usually I can find a solution Sometimes I push myself to do different things even I do not like it
1 (total disagreeme nt) frec %
2
3
4
5
6
7 (total agreement)
frec
%
frec
%
frec
%
frec
%
frec
%
frec
%
0
0
0
0
4
3
6
5
21
18
33
28
52
45
0
0
0
0
0
0
2
2
9
8
44
38
61
53
0
0
0
0
1
1
6
5
9
8
24
21
76
65
0
0
1
1
1
1
4
3
27
23
50
43
33
28
1
1
1
1
8
7
22
19
22
19
41
35
21
18
The prevalence of resilience is approximately=90 %, with undecided 7%, and 3%, disclosing unresilient behavior.
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The same calculation done on the entire sample is showing similar and different figures. This time, the factorial analyze depicts less latent factors (7 instead of 8 as it was to the previous samples) which explain the variance of the data. The communalities have only two indicators with similar values as in the previous cases (communalities>.70) as in the table below: Table 4: The resilience on students on psychology and economy: the items with best values in communalities Nr/ imp or tanc e 1
2
Question
For me is important to keep high interest for something. Sometimes I push myself to do different things even I do not like it
1 (total disagreeme nt)
2
frec
%
frec
0
0
4
2
3
4
5
6
7 (total agreement)
%
frec
%
frec
%
frec
%
frec
%
frec
%
0
0
6
3
11
5
33
15
70
32
96
45
6
3
19
9
42
19
41
19
73
34
31
14
Continuing the work on the data we have 29,5% resilient students, but 79,5 % moving in the resilient direction and only 12% undecided, with 8,5 % un-resilient. Table 5: The resilience of students in the research: comparing data Type
Resilient
psychology economics total/media
frec 24 48 36
% 24 41 32,5
Moving toward resilient estate frec % 49 49 56 48 52,5 48,5
Undecided
Un-resilient
Total
frec 15 8 11,5
frec 12 4 8
frec 100 116 108
% 15 7 11
% 12 3 7,5
% 100 100 100
The students in economics are apparently more resilient and the prevalence of resilience is quite high among the second generation: 81%. There is 19 % who need support. What is the prevalence of protective factors? What are the differences? In the case of students in psychology, taking in account the data on the protective factors, in the same way, out of 33, there are 5factors accounting for more than .750 of all the indicators. For economics, there are about 10 factors accounting for more than .750. The protective factors on all the respondents get smaller values on communalities and if we keep the selection based on the same accounting value (75%). The protective factors highlight the difference between the students in psychology and those who are in economics. Table 6: Protective factors: Economics Nr. 1
Items I use very often the humor for making the things less difficult
Yes 96
83%
No 20
17%
2 3 4 5
I have a trustful relationship with my partner I was raised-up in a loving atmosphere I have an easy temperament I have a good social network (friends, colleagues, members of my family to whom I am attached and from whom I can have a real support) My family offered me good material conditions I use to have or I have a pet When I need help I know how to find it I had the chance to meet a good mentor for me The parents’ expectations helped me to progress
60 107 87 110
52% 92% 75% 95%
56 9 29 6
48% 8% 25% 5%
105 58 111 61 91
91% 50% 96% 53% 78%
11 58 5 55 25
10% 50% 4% 47% 22%
6 7 8 9 10
On the students in psychology, the values on communalities are less high. There are only 5 items out of 33 which has the values higher than .750, as can be see bellow.
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Table 7: the protective factors for students in Psychology Nr. 1
Items I am useful to my community (for instance by doing voluntary work)
Yes 64
64%
No 34
34%
2
I have efficient strategy when facing the difficulties (I talk to other persons, I do sport, I take decisions) I was raised-up in a loving atmosphere I am happy to belong to my community (I share values, traditions, etc.) I had and I have interesting leisure time activities
84
84%
16
16%
79 76 78
79% 76% 78%
21 24 22
21% 24% 22%
3 4 5
Discussions The samples which we compare here are not homogeneous neither comparing the number, the gender, nor comparing the age and the year of the study of the respondents. Despite these disparities to put side by side the results as well as the work on the total sample gives interesting image about the resilience of the next generation of the old communist people in Romania. The way in which we work on the data, based on the communalities is just a half a way to real analyses on the data, which can be done. Communalities reveal just the saturation of each item with other items in the tool. Choosing the highest values in communalities we were trying to catch the superficial factors which account the best for the resilience, protective and risk factors.
Conclusions Is the second generation already healthy following the societal trauma brought by the communism? If we look at the results among students in economics, the sample answer is yes, in a great dimension (89% are showing good resilience or moving toward resiliency). We have to add that this generation is also capable to search for remedies. We consider the students in psychology (resiliency: 24%, moving toward resiliency:49%), in a great proportion as choosing to attend this study based on their own motivation to understand them self better and to repair the damages brought in their previous life by the adversities encountered including in relation to their parents and family. This idea is not new and several researchers found that the motivation underlying the career choice of mental health professionals may include a desire to resolve personal psychological distress from childhood or the need to continue the caretaking role hold in the family [3]; [4]; [5]. “An unsatisfactory childhood resulting from family dysfunction frequently leaves the children confused, empty, battling their own inner difficulties. As they attempt to come to terms with their own childhood, they may begin the study of psychology or social work. Indeed, the need to understand the self is one of the most frequent motivations cited when social service students are questioned about their interest in the field [6].” [5]. If we compare the resiliency’s indicators as well as the protective factors there are significant differences between the two samples. The respondents, who are students in economy, are more homogeneous as a group (age, year of study) and more consistent in their answers. The factors with high communalities in the resilient questionnaire are also privileged within the protective factors questionnaire (like humor, good social network, good atmosphere in the family, good self-esteem). These items are mentioned within the literature on resiliency as being important for facing difficult circumstances: the humor, the capacity to ask for support, the good social network, as well as enjoying leisure time activities and having dear pets. The students in psychology show less homogeneous aspects as a group (age, year of study) and less consistent responses to the questionnaire on resilience and protective factors. There are only 5 items with high communalities in resilience investigation and they are different comparing with the items in protective factors. This incongruence is probably also connected with the time spend for answering. A huge difference is evident on the table showing the time spent by students in doing their self-report. When the average time for students in psychology is 12,8 minutes (st.d.=2,3), the students in economy spend almost double time in average (m=22,8; st.d.=3,6). One of the specific aspects for PTSD is avoiding the memories of the traumatic or unpleasant events. When such event in the memories has to be avoided less time will be used to recall in the memory and to work on the answers in an honest way. When students have access to their memories, they take the time to explore them self and to give honest answers. Knowing the common motivation for aspirants in psychology and taking in consideration our results some supportive device or services can be developed and should be developed for students in psychology. The students in economy are more emotionally connected to their family, social networks, partner, pets and have better access to them self comparing with students in psychology who are more prone to experience different situation which can keep them active and participative. Participation has therapeutic effects. Again we can see the wised natural impulse on the way of healing process, at work.
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The last aspect which we mention here is that for both categories of respondents the self-discipline is an important aspect for their resiliency.
References [1] [2] [3] [4] [5] [6]
Ingleby, D. (2005). Forced Migration and Mental Health. Rethinking the care of refugees and Displaced Persons. Springer sciences and Business Media Inc Dordrecht. Fraiberg,S. (1980).Clinical studies in infant mental health : the first year of the life, Basic Books, New York. Nikcevic, AV, Kramolisova-Advany, J., Spada, MM (2007). Early childhood experiences and current emotional distress: what do they tell us about aspiring psychologists? J.Psychol. 141 (1), pp.25-34. DiCaccavo, A. (2002). Investigating individuals’ motivations to become counselling psychologists:the influence of early caretaking roles within the family. Psychology, Psychotherapy, 75 (4), pp. 463-472. Waterman, B.T. (2002). Motivations for Choosing Social Service as a Career. www.bedrugfree.net (downloaded February 2014). Hanson, J. & McCullagh, J. (1995). Career choice factors for BSW students: A 10-year perspective. Journal of Social Work Education 31 (1), 28-37.
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Resilience and personality. Orientation to failure as personality trait of Romanian people viewed from a historical perspective Nedelcea C.1, Ciorbea I.2, Ciorbea V.2, Iliescu D.3, Minulescu M.3 1
University of Bucharest (ROMANIA) University Ovidius of Constanta (ROMANIA) 3 National School of Political and Administrative Studies (ROMANIA)
[email protected],
[email protected],
[email protected],
[email protected],
[email protected] 2
Abstract Orientation to failure was identified in an exploratory factor analysis carried on the responses at Five Factor Nonverbal Personality Questionnaire collected from a national representative sample of 1600 adult participants. We started to investigate around this factor pointing to a cultural specific personality trait of Romanian people, aiming to describe its psychological meaning and potential impact on resilience at a social level and in the same time to identify if a historical - social explanation is possible for. The investigation illustrates an interdisciplinary perspective creating bridges between a clinical psychological perspective and a social - historical one. The paper presents the results coming from a number of qualitative investigations, done using a group of experts from social sciences and humanities, in order to describe the meaning of identified personality factor and its impact on resilience. The paper is also focused on presenting the main arguments and conclusions of a historical investigation, which was done to explore if development of a reasonable explanation is possible at social and cultural level for Romanian people for the existence of the identified factor. Also, the paper focuses on methodological details of the subsequent investigations. Keywords: personality, orientation to failure, interdisciplinary, historical perspective
Orientation to failure- a Romanian national trait An exploratory factor analysis carried on the items of a nonverbal Big Five questionnaire – FF NPQ [1], revealed a structure of 6 meta-factors of personality. We used in analysis the answers coming from the Romanian normative sample of FFNPQ, consisting of 1800 participants (900 males & 900 females) and being representative for the Romanian population over the age of 12. Although other investigations pointed out the hypothesis of a 6 broad personality factors [2], [3], [4], in contradiction with the main assumption of the Big Five model, the 6th factor obtained in Romania differs also from the 6th described by HEXACO model [5], [6] in addition to Big Five and seems to be rather culturally specific. By considering the items contents, we named this factor Failure or Orientation to failure. The 6th factor obtained covers 6,49% of data variance and groups 2 items staying as facets: Intolerance to loss (item 3, loading .66) and Failure in learning (item 19, loading .75). It represents, from a standard Big Five perspective, an unexpected finding, being a factor that does not relate with any of the classical 5 dimensions. It is factor of failure on an interpersonal level, a failure in the desire of selffulfilling, failure in learning and academic achievement. It identifies individuals with a high awareness for the concept of failure or otherwise negatively influenced by failure. Intolerance to loss is a facet emphasizing the difficulty in accepting the idea of loss in competitions, even though the stake matters. This facet identifies persons who do not enjoy losing and who display aggressive manifestations to loss. The item content is related to aggressive responses to loss in a sportive competition, loading also on Aggressiveness facet. The facet is not significantly loaded on any of the five Big Five dimensions. Failure in learning is a facet of failure in learning and academic achievement, with a content related to rejection due to failure. The factor has no significant meaning on any of the classical Big Five dimensions. Item 8, having the major loading on the Consciousness dimension, also load higher than .30 on the Failure. This item is supplementing the significance of the facet with a content related to failure in academic accomplishments. The significance and validity of the 6th factor obtained was further explored by using a number of qualitative investigations with experts and a peer nomination procedure. The peer nomination procedure using a
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group of 93 high school students demonstrated an average correlation coefficient of .26 between self-report scores and evaluations on the same constructs made by peers. The analysis on expert opinions leaded to the conclusion that a failure orientation factor has both psychological coherence, as well as historical and social resonance in the Romanian cultural context. This personality trait of Romanian people may significantly impact the general adaptation (e.g. resilience) and can play an explanatory role for different Romanian social realities. As we were able to bring proofs regarding the validity of our findings and in the same time as it is very likely that the presence of this trait is connected to some real historical and social moments of the Romanian people (it can be interpreted as an expression of a fatalist feature, present in Romanian personality after centuries of domination and oppression), we decided to search for a comprehensive historical explanation on it.
Historical Explanation If cross-cultural research reveals a culturally specific dimension, variation on that dimension may be uniquely important within that culture’s particular social context [7]. In order to explain this trait it must be taken into account the Romanians` historical experience. Just as an individual personality is structured during its developmental stages, the core personality of a nation we can assume is structured during its formation and evolution. Romanians appeared as a result of an historical process not different from the one of other nations of Latin origins [8].The common element of these nations is the Roman component and the difference is due to other layers. For Romanians the ethnic base was the Geto-Dacians. All the ancient written sources highlight a main common trait of Geto-Dacians: the powerful belief in their immortality. This serene acceptance of death made them highly brave in battles as mentioned by Ponponius Mela and Emperor Iulian Apostatul (361-363 d. Hr.) [8]. Furthermore, after the Roman troops conquered Dacia in 106 AD, the king Decebal chose suicide than the captivity humiliation. Transforming Dacia in Roman province set off the Romanization - the essence of the acculturation process [9]. All the Dacians acquired the popular Latin language, which become the engine of the Romanization process. From the late third century until the thirteenth century, the Romanians people had to face the migration era. The Slavs constituted the most important layer in the formation of the Romanian people whose contribution remained imprinted in the language. Also the Romanians assimilated several other migratory. The historians presented the Romanian people as „an enigma and a miracle", meaning that they managed to survive surrounded by a „sea of Slavs”, without losing identity [10]. The people managed to diminish the migratory impact also by retreating in the woods and in the mountains - hence the popular saying "the wood is the brother of the Romanian". It seems that historical proofs indicate that the main objective for the people was survival. The Romanians` strength and durability in the migration era and the succeeding ones, was given by "the admirable Romanian village" [11]. Villages were the main organizational forms that assured the shaping and development of the Romanian civilization. The people ensured their existence through working the land and animal breeding. From the thirteenth century it began the formation of the fairs and cities as product distribution centers and, then as handicraft production units; thus the city dwellers category expressed other types of community relationships and behaviors different from the villagers. Moreover, the Romanian feudal states were formed which meant a long, difficult economic and military effort, with negative consequences for the economic and social development. Whether they fought the Turks, Poles, Tatars and Hungarians, the major objective was the defense of the political identity and the religious faith. The methods used to achieve these aims were battles and negotiations. The most difficult and asymmetric conflict was the one with the Sublime Porte (the government of the Ottoman Empire) that took place for more than four centuries. The Romanian people maintained their autonomy and self-government in exchange for financial and material obligations. As the Ottoman domination enhanced, especially during the Phanariot rule (1711-1821), a new psycho-moral behavior appeared - the so-called “diplomacy of the tip” [12]. The Ottoman impact on the Romanian mentality manifested through some fundamental psychological aspects which continued even after the Empire`s disappearance: a powerful habit of bribery, a deep fear and distrust in authority, a strong sense of humility, compliance, obsequiousness or obedience. All this time, the vast majority of the population – the peasants – was the one that had to sustain all the financial debts through hard work and giving up their lands and freedom. They all lived in poverty, deprived of formal education and their main goal was survival. In the first half of the nineteenth century the peasants` material and social situation remained dramatic. They lived in extreme poverty under barbarian physical punishments aimed to intimidate and compel them to the taxes payment. They were fleeing from the states representatives hiding in the woods and mountains [13] - the same strategy of resistance used in the migration era and also a survival strategy. In 1835, Helmuth von Holtke, a German Field-Marshal that had knew the country, described a generalized Romanian behavior: "Every welldressed man makes an impression on the Romanian who considers him, fully entitled to command and to claim services from him... and in the same time he receives quietly the mistreatment. The Romanians lived in
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miserable huts and were dressed in rags [14]. After the Treaty of Adrianople in 1829 which removed the Ottoman economic monopoly on Romanian Principalities` trade, the development of capitalism and its new social class – bourgeoisie - accelerated. From the late eighteenth century an acculturation phenomenon emerged in the Romanian Principalities. Part of the Romanian elite borrowed elements of French culture without having the bribery and favors practiced in the Phanariot era to be eradicated but even more amplified by the capitalism`s flaws.The year 1848 found the Romanians in the European revolution turmoil. Political programs and actions aimed major reforms for the Romanian society: unity, independence, rights and freedoms, empowerment and land reform. In Transylvania, the crucial issue was the struggle for national defense due to the condition imposed by the Austro-Hungarian nobility regime – even though they were the majority, the Romanians were considered tolerated. In a favorable European context the Principalities of Moldavia and Wallachia were united in 1859 under the rule of Al.I.Cuza. There had been implemented major reforms to modernize the Romanian society; the most positively remembered was the land reform that positively marked the peasants on the psychological level [15]. Removing Cuza in 1866 brought to the throne of Romania a stranger monarch – Carol I. His will, however powerful, hadn`t managed to change the Romanian mentality. Romania was essentially an agrarian and patriarchal society. The politicking, the cronyism and the counterproductive attitudes coming from the distant past have made the Romanian entire society`s modernization and change extremely slow. The War of Independence of 1877-1878 meant some notable successes: the state independence from the Ottoman Empire and increased linkage to the European model. Regardless of these breakthroughs the Romanian economy has remained mostly agrarian. The vast majority of Romanians lived in archaic rural villages; they showed a lack of concern for industrial activities due their powerful belief that “the use of natural forces and tools (meaning industrialization) is the Evil`s invention that upsets God” [16]. On the other hand, the peasants lost their properties again (by division and inheritance) and in the early twentieth century the key issue was again the lack of land ownership. The main drive for the Romania's participation in World War I (1916-1918) was the union of the territories there were still under the foreign rule of Austro-Hungarian and Tsarist Empires. In 1918 Romania succeeded to unite Basarabia, Bucovina and Transilvania to the main country and formed “The Great Romania”, an event sustained by all social classes from the peasants to the royal family. This opened new developmental prospects and the opportunity to implement the land reform and the election reform. Still the Romanian society preserved its past flaws: "blunted critical sense, bargaining, inversion of values, morbid passivity, acceptance of attacks, tolerance of injustice, old fatalism reverberation - all determining confused boundaries and evil in the public consciousness” [17] – that affected and diminished the hopes brought by the Great Union. The Romanian society as a whole entered in the new era as an organism marked by inner diseases but hidden by those who were meant to lead it [18]. In fact, the peasant psychology remained - as an individual the Romanian was interested in ensuring the daily existence and in the group, he was marked by “gregariousness” – the constant trait to obey the authorities till the loss of his individuality in the crowd he is part of [19]. Gregariousness saved the Romanians in the past but for the future it was a break for development; the progress for the people should be an intense differentiation of of skills and character among members of the society [20]. The geopolitical changes at the beginning of the World War II led to the collapse of Great Romania by ceding some essential territories to the revanchist states pressure (USSR, Germany, Italy, Hungary, Bulgaria). This situation has also been explained by the life concept of the epoch marked by "frivolity, luxury, idleness, truancy, favoritism, theft, etc.” [21] that didn`t create a natural collective reaction but an acceptance response to the situation. The geopolitical objective of the Romanian participation in the eastern campaign against URSSS failed in 1944 when Romania turned the weapons against the German and allied with the United Nation Coalition. As a consequence the Soviets occupied Romania and imposed an extremely harsh Stalinist regime. Following the Soviet model, the Romanian political elite and all those who were perceived dangerous regardless the social class have been incarcerated as a result of serious legal abuses. The communist period, especially Ceausescu`s regime, was marked by several key aspects: the permanent surveillance and control of the people; multiple deprivations (food, water, electricity, warmth, information); the authoritarian regulation of personal and collective space (e.g. nationalization of buildings and lands); sexuality control (e.g. prohibition of any birth control methods); prohibition of any religious activities; prohibition of any relationships with foreign citizens; indoctrination with Marxist philosophy. Therefore there was little and timid resistance movements that were continuously suppressed by the secret police (securitate). The main instrument of political power was the terror [22] through violent oppression, abuses and numerous crimes [23]. Also, it`s essential to mention that any existing opposition was very difficult due to the intense admiration for Ceausescu`s policy expressed by the main powers in the world. The continuous life degradation, the country's isolation from the rest of the world, the constant propaganda for the dictator's family determined powerful frustrations that exploded in December 1989 in the context of the revolutionary changes in the neighboring countries and of the URSS` lack of involvement. The Romanian revolution was one of the few moments in their history in which the people publicly reacted together, expressed their discontentment and ruled in favor of a radical shift.
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Reviewing the main historical experience of Romanians point some major patterns: their past has largely been determined by others; they had little opportunity to determine their own fate; the vast majority of the people almost constantly lived in fear, poverty and terror; they had little opportunities to evolve at an educational, economic level; they had to find some ways to survive in these aversive circumstances.
Psychological Explanation The evolutionary perspective on the Big Five holds that humans have evolved “difference-detecting mechanisms” to perceive individual differences that are relevant to survival and reproduction [24]. Buss views personality as an “adaptive landscape” where the Big Five traits represent the most salient and important dimensions of the individual’s survival needs. Briefly, people have mechanisms that currently exist because in the evolutionary past they have successfully solved specific adaptive problems. In a history marked by the domination of the big powers, Romanians have developed a trait that helped them adapt and ultimately to survive as a nation. Fatalism leads to resignation and passivity; it is the trait that helped them cope with aversive historical conditions. The resilience model [25], [26] can further deepen the psychological explanation of the failure orientation`s structuring in the Romanian nation`s soul. What is (the existence of such personality factor in Romanians) has meaning only by framing it into the past and into the future. The interactions between vulnerability factors, the risk factors, the resilience and protective factors offer a complete and comprehensive perspective of the psychological functioning and recovery/healing of the Romanian people. The first psychological trait that can be considered the foundation of the Romanian nation is the fundamental belief in the immortality of the soul. If this belief made the Dacians brave and fearless in battles, further, under the traumatic events in the Romanian history, it made the Romanians able to accept the adverse conditions. It should be mentioned that this ancestral belief has been further reinforced by the orthodox religion – where life is the God`s choice and judgment over people and justice would come into after-life. “Therefore, the Romanians almost don’t personalize their feelings so that the Ego becomes dominant. They are ready to rise above the Ego, into a sort of Super-ego, philosophical and, implicitly, fatalist, that enables them to accept the reality with all its manifestations, because the Good as the Bad, when are considered predestined, can be easily and resent less accepted as parts of a divine schema” [27]. Secondly, philosophers and other scholars have mostly mentioned and discussed one trait of the Romanian people: the fatalism as a “national characteristic”. Most of them perceived it in terms of Romanians` ancient and strongly anchored belief in eternity of life. For example, the well-known Romanian philosopher Mircea Vulcanescu explained the Romanian fatalism as an integration of a being into universality of existence [28]. The philosopher and poet Lucian Blaga, deeply preoccupied by the specificity and identity of every nation, introduced the concept of “stylistic matrix” to explain and analyze the deeper archetypal reality of a nation`s soul. Starting from the most emblematic folk-ballad for the Romanians - Miorita (The ewe-lamb) – Blaga draws the conclusion that the stylistic matrix for the Romanians is the “mioritic space”, meaning that the transfiguration of death is a logical consequence of resignation and fatalism [29]. Thirdly, regardless the historical stage, the resistance (survival) of the Romanian nation seems to be the common central behavior and can be seen as a major over-compensatory mechanism in front of all the adverse conditions. The psychological consequences of the lived historical experience for the Romanians were: constant fear, helplessness and horror which can be framed as traumatized parts of the soul. The constant hiding of the people from different and numerous invaders is perceived by Cioran (1911-1925), writer and philosopher, as a search for safety [30]. The Romanian society has been constantly brutalized and became incapable of voicing a protest but passively accepting every ignominy that it is called upon to bear with monotonous regularity [31]. Somehow, maybe as sign of learned helplessness (a main mechanism of depression), Romanians seem to have internalized the belief that evil always wins and they are condemned to fatalism and contemplation. In a study on the main strategies used by Romanians to deal with the communist atrocities, the essential one mentioned was “the acceptance of the unacceptable” [23]. Mircea Eliade (1907-1986), Romanian historian of religion, writer, philosopher, and professor at the University of Chicago, thoroughly analyzing the so-called passivity of Romanians understands the resigned attitude as a more deeper existential decision: “one cannot protect himself from the destiny as one cannot protect from the enemy; all one can do is to impose a new meaning to the unavoidable consequences of a meant-to-be destiny. It is not fatalism, because the fatalist doesn`t consider himself capable to change the meaning of what was predestined [32]. This unconscious “choice for resistance” can also be considered the main resilience factor used by Romanians for a long period of time. In front of traumatic events, one can rely on what brings strength. Ernest H. Latham, the author of a paperwork published in the United States about the legendary ballad, perceives the fatalism of the people in a different manner: “sat by fate on the border of West and East, after two thousand years of harsh rule, barbarian invasions, greedy conquerors, by evil rulers, cholera and earthquakes gave the
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Romanians the feeling of temporary and transitory qualities of things (...) Romanians possess the greatest ability to get relaxed blows of fate. They know how to fall with art, with every muscle and every joint soft and relaxed ... The secret art of falling is, of course, do not be afraid, and Romanians are not afraid, as the Westerners are. A long experience in survival taught them that every failure has unimagined opportunities and that, in one way or another, they`ll manage to put themselves together on the feet again" [33]. In the same time, what functioned as a coping mechanism for almost all Romanian history, nowadays – in a free, democratic regime – has proven to be a risk factor for developing pathological behavior. While today Romanians have the opportunity to choose their own fate, to evolve as a nation, the resistance continues (as if they are still under foreign occupation - in history, in a past already ended) and it has transformed itself into what we called orientation to failure. Today, Romanians as a whole, still don`t speak up for themselves, still don`t know their rights and still accept any injustice – and they cope with all in the same manner as before: with profound resignation and passivity. This lead to what William Wilkinson, British counsel at Bucharest from 1814 to 1818 long before called “intolerable servitude”, “lack of hope for a better condition”, “habitual depression of their minds that become natural stupor and apathy, which renders them indifferent to the enjoyments of life, and insensible to happiness, as to the pangs of anguish and affliction” [34]. Also, Felix Colson, secretary to the French consulate in Bucharest from 1835 to 1840, mentioned the Romanians as “humble, submissive and ready to endure anything; their hollow eyes, which they dare not raise, proclaim their slavery absence of well-being” [34]. These attitudes lead to specific behaviors that, in turn, today and in the future, have only one major consequence: failure. For example, the Romanian novelist Augustin Buzura clearly described this in-depth and generalized attitude of the people, as a mark for future failure: “The greatest catastrophe is that we have become accustomed to servility, that we no longer recognize it, that we have grown to tolerate it, that we allow ourselves to be transformed by it, that we have become accomplices to it, so we cannot shake off the image which it has bestowed upon us even when we are alone” [31]. What is to be done under such psychological grounds? Analogically with the healing process in a traumatized soul [35], the recovery and healing process of a nation follows the same path. The national acknowledgment of the psychological wounds and their consequences for this nation`s soul can be done through national programs and politics that aim: honesty in presenting the historical facts together with understanding of the psychological consequences - deep pain and need for survival of the common people. This can bring reintegration of the traumatic dissociated part of the nation. Along with this, the development of healthy parts of this nation should begin: the re-establishing of national self-esteem and authentic Romanian honor; developing the real power of decision and action “here-and-now”; developing the optimism and the ability to enjoy life; acknowledging the existence of the free-will. Of course, further suggestions are expected from the future investigations on the topic opened by the present paper.
References [1] Paunonen, S.V., Jackson, D.N. & Ashton, M.C. (2004). NPQ Manual. Nonverbal personality questionnaire and five-factor nonverbal personality questionnaire. Porthuron: Sigma Assessment Systems. [2] Paunonen, S. V., Jackson, D. N., & Ashton, M. C. (2004). NPQ manual. Nonverbal Personality Questionnaire and Five-Factor Nonverbal Personality Questionnaire. Port Huron: Sigma Assessment Systems. [3] Jackson, D. N., Ashton, M. C., & Tomes, J. L. (1996). The six-factor model of personality: facets from the Big Five. Personality and Individual Differences, 21, 391–402. [4] Jackson, D. N., Paunonen, S. V., Fraboni, M., & Goffin, R. D. (1996). A five-factor vs. six-factor model of personality structure. Personality and Individual Differences, 20, 33–45. [5] Jackson, D. N., & Tremblay, P. F. (2002). The six factor personality questionnaire. In B. DeRaad and M. Perugini (Eds.), Big five assessment (pp.353-375). Gottingen: Hogrefe & Huber. [6] Lee, K. & Ashton, M.C. (2004). Psychopathy, Machiavellianism, and Narcissism in the Five-Factor Model and the HEXACO model of personality structure. Personality and Individual Differences, 38, 1571–1582. [7] Lee, K. & Ashton, M. C. (2004). Psychometric Properties of the HEXACO Personality Inventory. Multivariate Behavioral Research, 39, 2, 329 - 358. [8] Yang, K.S., & Bond, M. H. (1990). Exploring implicit personality theories with indigenous or imported constructs: The Chinese case. Journal of Personality and Social Psychology, 58, 1087-1095. [9] Giurescu, C. C. & Giurescu, D.C. (1975). Istoria românilor. București: Editura Științifică și Enciclopedică, pp.32-33. [10] Constantiniu, F. (1997). O istorie sinceră a poporului român. București: Univers Enciclopedic. p. 36.
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[11] Bratianu, Gh.I. (1988). O enigmă și un miracol istoric: poporul român. București: Editura Științifică și Enciclopedică. [12] Iorga, N. (1938). Originea, firea și destinul neamului românesc. În Enciclopedia României I, p.37. [13] Constantiniu, F. (1997). O istorie sinceră a poporului român. București: Univers Enciclopedic. p. 182. [14] Ibid, p. 208. [15] Ibid, p. 209. [16] Ibid, p. 234. [17] Rădulescu-Motru, C. (1938). Însușirile sufletești ale populației în viața economică a României. În Enciclopedia României, III, p. 69. [18] Goga, O. (1992). Mustul care fierbe. București: Scripta, p.181. [19] Constantiniu, F. (1997). O istorie sinceră a poporului român. București: Univers Enciclopedic. p. 318. [20] Schifirneț, C. (1999). Studiu introductiv. Concepția lui C. Rădulescu-Motru despre psihologia poporului român. În C. Rădulescu-Motru, Psihologia poporului român. București: Albatros, p. XXIX. [21] Rădulescu-Motru, C. (1938). Însușirile sufletești ale populației în viața economică a României. În Enciclopedia României, III, p. 11. [22] Constantiniu, F. (1997). O istorie sinceră a poporului român. București: Univers Enciclopedic. [23] Deletant, D. (2001). The Securitate legacy in Romania. În K. Williams & D. Deletant (Eds.)’ Security intelligence services in new democracies. The Czech Republic, Slovakia and Romania. London: Macmillan, pp.159-211. [24] Ionescu, Ș. & Muntean, A. (2013). Reziliența în situație de dictatură. În Ș. Ionescu (Ed.)’ Tratat de reziliență asistată (pp. 295 -514). București: Trei. [25] Buss, D. M. (1996). Social adaptation and five major factors of personality. In J. S. Wiggins (Ed.)` The fivefactor model of personality: Theoretical perspectives (pp. 180-207). New York: Guilford Press. [26] Ionescu, S. & Blanchet, A. (coord.). (2009). Tratat de psihologie clinică și psihopatologie. București: Trei. [27] Ionescu, S. (coord.). (2013). Tratat de reziliență asistată. București: Trei. [28] Barbu, M. (2000). România în pragul mileniului III. Renașterea Optimismului. București: MondoMedia. [29] Vulcănescu, M. (1991). Dimensiunea românească a existenței. București: Editura Fundației culturale române, p.115. [30] Blaga, L. (1936). Spațiul mioritic. București: Cartea Românească. [31] Cioran, E. (2006). Schimbarea la față a României. București: Humanitas. [32] Deletant, D. (1995). Fatalism and Passiveness in Romania: Myth and Reality. Saeculum. Revista de sinteză literară, 3-4, 12, pp. 75-87. [33] Eliade, M. (1995). Mioara năzdrăvană. În De la Zamolxis la Genghis-Han. București: Humanitas (p. 260). [34] Latham, E. H. (2002). Interview recorded by Ion Longin Popescu, Formula AS, 535. [35] See Deletant, D. (1995) Fatalism and Passiveness in Romania: Myth and Reality. Saeculum. Revista de sinteză literară, 3-4,12, p. 77. [36] Ruppert, F. (2008). Trauma, bonding & family constellations. Steyning: Green Baloon Publishing.
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Alice, the survivor Paries C.1, Mandart J.-C.2, Le Doujet D.3 1
Établissement pour Personnes Âgées Dépendantes, Psychologie & Vieillissement, France Centre Hospitalier du Centre Bretagne (CHCB) ; Psychologie & Vieillissement, France 3 Psychologie & Vieillissement, France 2
Abstract Alice lives her life normally. She is married. She works. Her children are growing and go to live their lives. Her husband dies, she must live alone. One day she falls. Thigh bone fracture. Not appropriate medical recovery, impossible to walk again. She becomes dependent. She should enter a special caring service for retired. The slipping syndrome is mention. A request was made by the team to a psychologist. He will assist her resilience. Then, Alisa starts to tell her ordinary life story and the past will repeat in the present: her survival after the bombing during their childhood. Key words: assisted resilience, social theory of memory, survival
Syndrome de glissement? Pendant la seconde guerre mondiale, à 6 ans, Alice fuit sous les bombes, avec son père et son frère. Une bombe explose à proximité. Alice est enterrée vivante ! Elle ne peut pas bouger, elle est coincée, elle est sous la terre, et pratiquement asphyxiée, elle se sent mourir. Une deuxième bombe souffle la terre déposée par la précédente. Alice reprend sa respiration, se relève et voit à côté d’elle les cadavres allongés de son père et de son frère ! Elle est désormais une survivante. Entre Ulysse et Alice, quels points communs ? Jean-Pierre Vernant raconte Ulysse au retour de la Guerre de Troie, guerre meurtrière : Il évite de rentrer immédiatement chez lui, vu le sort du chef de l’expédition, Agamemnon, assassiné par sa femme Clytemnestre et son amant. Ulysse accomplit alors un long voyage ordalique et expiatoire. Il y perd son nom, ses compagnons, il visite les confins de la terre et de la vie, il parle avec les héros qui, tel Achille depuis l’enfer, l’invitent à prendre le chemin de la vie plutôt que celui de la mort, fût-elle glorieuse. Au bout de vingt ans d’errance, enfin, il retrouve son Ithaque. Prudent, il s’y présente vieux, méconnaissable. À l’inverse de Clytemnestre, Pénélope a cultivé l’absence de son époux et refusé de saturer le vide physique laissé par son départ, prendre un amant ou un nouveau mari, bien qu’elle eût mis un enfant au monde, conçu quelques mois avant le début de l’expédition. Les nombreux prétendants présents au palais festoient, se servent allègrement des biens et des richesses de l’absent, déciment et dévorent ses troupeaux. Transformé en vieillard hideux, Ulysse se déguise en mendiant. Une de ces ruses de guerre qui lui ont maintes fois sauvé la vie. Alice quant à elle fait sa vie, sans qu’apparaissent de séquelles visibles de l’incident critique qui a failli la tuer, comme son frère et son père. Elle se marie. Elle a des enfants. Devenue veuve, elle demeure dans la maison jusqu’au moment où une chute lui fracture le fémur. Impossible de demeurer seule chez elle. La décision médicale s’impose : elle doit rentrer en maison de retraite, pour une longue et difficile rééducation. L’enfermement l’immobilisation forcée, la dépendance aux autres, côtoyer les personnes âgées dont certaines vont mourir, c’est insupportable ! Elle s’enfonce dans une dépression d’allure mélancolique. Alice repousse les aides, ne mange plus, refuse la rééducation. Elle se laisse mourir. Un syndrome de glissement ?
1.1
Assistances
L’équipe s’alarme et demande l’aide d’un psychologue. Il travaille également aux urgences de l’hôpital voisin où il rencontre des personnes choquées, traumatisées. Son travail consiste à générer une situation d’interlocution afin d’aider les victimes à sortir de leur mutisme, de leur terreur. Il adopte une méthode active, empathique, adaptée pour les personnes impuissantes à surmonter seules l’effondrement consécutif aux événements critiques, lorsqu’elles ont vécu la mort. La seule trace d’Ulysse en Ithaque réside en creux dans l’attente de son retour. Il doit d’abord lutter contre le mendiant habituel, irrité par la concurrence. Il doit trouver des alliés qui vont l’informer et l’assister pour retrouver sa place, son identité. Seul, il est impossible d’y parvenir. Sa vieille nourrice, ayant mission d’accueillir tous ceux qui entrent dans la ville et seraient susceptibles d’apporter des nouvelles d’Ulysse, le
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reconnait en premier. Par un détail insignifiant à d’autres : une cicatrice au mollet, faite par un sanglier lors de son initiation de jeune guerrier. Elle sait qui il est et il comprend qu’elle sait. Avant qu’elle puisse crier sa surprise, il lui met la main devant la bouche pour l’empêcher d’éventer la ruse. Sa nourrice retrouve en lui l’enfant et le jeune homme blessé. Télémaque, né après son départ, n’a pas connu de père et son père n’a jusqu’alors jamais joué ce rôle auprès de lui. C’est chose faite aussitôt qu’Ulysse lui intime d’autorité l’ordre de le croire sans discussion quand il lui affirme son nom. Ulysse devient père au moment même où Télémaque devient fils. Ils naissent l’un à l’autre en un seul instant par l’établissement de la relation d’autorité. L’assemblage de la constellation des identités relationnelles se poursuit.
De la mémoire sociale à la résilience assistée Le psychologue aborde Alice selon cette technique adaptée, prenant le temps d’être une présence identifiée, de se faire accepter, de faire naître la confiance et le transfert. Alice s’habitue et se met petit à petit à lui parler. Son vécu d’impuissance physique et son enfermement actuels la replacent dans des conditions analogues à celles du bombardement : un enterrement avant l’heure ! Cette concordance rend manifeste le vécu traumatique de poly-victimisation. Elle revit corporellement son expérience d’enfance et la raconte dans le même instant d’interlocution. Son appareil psychique construit simultanément du souvenir, du passé, du présent sur le modèle de la mémoire comme objet social selon Pierre Janet. Ce dernier expliquait qu’un témoin engendre le temps de l’humain en récapitulant son expérience sous la forme d’un récit adressé à un autre, légitimement institué comme référence, par son métier, sa pratique, son statut social. Janet annonce une théorie possible de la résilience assistée par interlocution et abréaction. Il expose une théorie sociale de la mémoire. Que veut-il dire par là ? La mémoire humaine s’inscrit dans un scénario relationnel voisin de celui du théâtre : les lieux, les actions, les personnages, la durée et sa structuration, le déroulement et la conclusion forment un ensemble cohérent et nécessaire. Ainsi, le guetteur d’une tribu préhistorique est-il, par son chef, chargé de veiller, d’observer, de donner l’alerte si un danger menace, et de faire le rapport le lendemain. La dramatisation, la scénarisation, les relations sociales interviennent pour mettre en souvenir ce qui le jour suivant sera restitué sous forme de récit adressé au chef. Par délégation, le veilleur de nuit doit être attentif à ce qui pourrait se passer. Il sélectionne les éléments à observer car a priori ce n’est pas le nuage qui passe devant la lune qui intéresse le destinataire du rapport à venir. Le déjà attendu, avant même que rien ne se fasse ni ne se passe, introduit par anticipation ce qui dans l’après du jour suivant deviendra le récit du présent de la nuit passée. Récapitulation faite dans le rapport à celui qui s’est physiquement absenté, mais dont la demande agit toute la nuit comme anticipation dans l’esprit du veilleur et mobilise son attention. La délégation de responsabilité permet l’absence physique du chef et oriente le devenir car le récit lui sera adressé au moment voulu, à son retour. C’est l’architecture de la formation du souvenir selon la théorie sociale de la mémoire. Nous y ajoutons des éléments théoriques de la psychologie historique proposée par Ignace Meyerson, reprise et illustrée par Jean-Pierre Vernant, insistant par l’exemple d’Ulysse sur la nécessité de réinvestir des rôles relationnels pour exister. Les techniques de la résilience assistée s’appuient sur la structuration du temps et des rôles sociaux. Dans l’après coup des événements critiques paralysant l’appareil psychique, le cadre proposé soutient la formation du souvenir par le récit adressé. En effet, la brutalité, l’imprévisibilité, la sidération empêchent la mobilisation spontanée des ressources résilientes pour traiter l’événement. L’avenir n’est pas possible. La rupture de la continuité chronologique génère l’effondrement de l’histoire et de la géographie humaine, partielle ou totale, de l’Être. Il n’y a plus d’autre, sinon mort. Le petit théâtre social de la mise en scène du monde réel sous forme de représentation ne se construit pas dans l’instant. De même, lorsque la personne affectée de troubles post traumatiques forge le discours qu’elle adresse au thérapeute, la participation active de ce dernier dans le cours du traitement contribue à sélectionner ce qui doit se dire. Les paramètres de la communication inter humaine sont sollicités. D’où l’intérêt de l’architecture psychosociale de la mise en scène.
Alice, la résilience assistée et les autres À partir du moment où Alice a pu verbaliser/représenter/signifier cette expérience, la raconter sous forme d’un récit adressé au psychologue patenté, elle a pu accepter de surmonter son handicap du moment, accepter aussi des aides, accepter qu’il y ait une amélioration possible, être partenaire du projet de soins et être meilleure actrice dans la rééducation. Le temps du passé étant advenu, le temps du présent peut reprendre son cours et Alice peut reconquérir ses rôles sociaux actuels. À la différence de ces nombreuses personnes âgées qui répètent indéfiniment la même séquence de leur vie, mais que personne n’entend comme manifestation post traumatique à travailler comme telle par résilience assistée. Ce n’est pas entendu comme un récit en souffrance, et par voie de conséquence, ce n’est pas un récit. Au mieux une récitation lassante pour les destinataires qui ne se reconnaissent pas dans ce rôle et dont les
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répliques sont décalées : mais Madame, vous savez bien que votre mari est mort ! Il ne peut pas vous entendre lorsque vous criez, enfin ! On vous l’a déjà dit. Se méprenant sur l’intrigue de la pièce, ils font bifurquer le scénario. Les cris risquent alors d’être entendus comme la manifestation d’un comportement troublé chez une personne désorientée dans le temps, qui a perdu la mémoire, avec des conséquences médicamenteuses possibles, circonstances aggravantes. D’autres personnages s’immiscent en la scène qui se joue, sans imaginer le traitement post traumatique. L’atelier mémoire sera d’un piètre recours.
1.1
Ulysse revient à lui-même
Ulysse, advenu père vingt après la naissance de Télémaque simultanément devenu son fils, redevient également le fils de son père, retiré dans une ferme à l’écart de la ville, affligé par tout ce qui se passe dans le palais dont il fut autrefois le maître. L’identité d’Ulysse se reconstruit au fur et à mesure qu’il peut habiter à nouveau les rôles déterminés par les relations personnelles, uniques et identitaires, entretenues avec sa nourrice, son fils, son père, puis bientôt sa femme qui l’attend et l’espère, mais ne le reconnaît pas encore en ce vieillard : il doit revisiter au préalable le rôle du fiancé. Pénélope donne alors le signal de l’épreuve qui doit départager les prétendants. Il s’agira d’utiliser l’arc dont seul Ulysse parvenait à se servir. Celui qui atteindra la cible sera digne de rejoindre la couche de la reine. Tous s’y essayent. Personne n’y parvient. Le mendiant demande à son tour de tenter l’expérience. Tous les vaillants jeunes hommes dépités se font des gorges chaudes à l’expression de cette prétention sénile. Néanmoins il lui est accordé le droit d’essayer. Il bande l’arc, contre toute attente, mais, toujours aussi rusé, il fait mine de manquer la cible. La flèche atteint mortellement un premier prétendant. Il recommence et manque encore la cible officielle. Puis avec l’aide de Télémaque, du porcher, du bouvier, les cent prétendants sont immolés malgré leur volonté de fuir. Le calme revient, la salle est nettoyée, purifiée du sang versé. Ce vieillard est bien singulier ! Mais Pénélope n’y reconnaît pas l’homme jeune qu’était son mari parti pour la Guerre de Troie. Ulysse doit encore, dernière épreuve identificatoire, résoudre une énigme piégée. Sera-til, lui le guerrier rusé, capable d’échapper à la dernière ruse de Pénélope ? Elle propose de déménager le lit conjugal dans une autre pièce avant de sceller leur union, s’il est bien cet Ulysse qu’il prétend être. Elle sait, et elle seule sait, que seul le véritable Ulysse connaît aussi la réponse. Non, dit-il, le lit ne sera pas déménagé. Et pour une raison simple : c’est lui, Ulysse qui l’a fabriqué de ses propres mains. Et il n’est pas possible de le déplacer car un olivier enraciné fait office de quatrième pied. Il doit donc demeurer, ce lit, immuable, à l’endroit où il a été fabriqué. L’arbre, faisant lien entre la Terre des hommes et le Ciel des dieux. Il est bien Ulysse !
Échapper à la fausse résilience Alice reprend aussi le cours de sa vie. Elle participe activement à sa rééducation, s’intéresse à son environnement, propose son aide serviable aux personnes qui manquent d’autonomie. Elle joue son rôle social au présent. Le travail de résilience assistée lui a permis de sortir de la fausse résilience qui avait suivi le bombardement. Elle avait continué de vivre sans séquelles apparentes. Cela n’a pas empêché un travail souterrain de production de traumatisme. L’incubation a pris des années et le déclenchement fortuit de sa présence en a révélé les ravages. Pendant tout le temps de l’apparence victorieuse, elle a réussi sa vie. Comme Œdipe avait aussi réussi en apparence, après avoir tué son père et épousé sa mère. Il avait débarrassé sa ville affaiblie par la Sphynge mangeuse d’hommes jeunes en résolvant l’énigme de l’Homme. Faussement résilient, Œdipe franchit victorieusement l’épreuve du mariage, sans séquelles apparentes. Ce que la suite de l’histoire va contredire. Le malheur va à nouveau s’abattre, sur la ville, et sur lui par son insistance à vouloir connaître la vérité sur ce forfait accompli par cet homme qui a tué son père, épousé sa mère dont il a eu des enfants. Il cherche la vérité et trouve sa propre vérité, aveuglante, qui lui crève littéralement les yeux. Le malheur des Atrides tient à ce que la matrice de l’architecture des vies et des morts, des filiations, des préférences sexuelles, des mariages, est torsadée. L’histoire et la géographie deviennent incohérentes, accidentogènes. Laïos, le père d’Œdipe, momentanément écarté du pouvoir à Thèbes et réfugié à Corinthe, était tombé amoureux de Chrysippe, le fils du roi Pélops. Il avait tenté d’obtenir une relation sexuelle non consentie. Chrysippe s’en était suicidé. Accidents en chaîne sur trois générations : Œdipe, fils de Laïos, épouse sa mère Jocaste et lui fait des enfants qui seront à eux-mêmes des ennemis plutôt que d’être fraternels. Les rôles sociaux sont brouillés. À la différence d’Ulysse pour qui le fils est fils, l’épouse est épouse, le nourrisson est bien le jeune homme, le mari est bien le mari. Fausse résilience chez Œdipe et Laïos, résilience assistée réussie pour Ulysse.
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Conclusion La fausse résilience nourrit un chancre intime qui dévore les forces vives de l’hôte, à la manière des prétendants au trône d’Ulysse qui épuisaient ses ressources domestiques en son absence. Après la crise, à l’issue de l’assistance à la résilience, Alice reprend le cours de la nouvelle vie. Elle a réintégré l’autre dans son rôle d’autre à qui le récit de vie est adressé.
Bibliographie [1] [2] [3] [4] [5] [6] [7]
Colette Aguerre : La résilience assistée au service du bien vieillir, in : traité de la résilience, sous la direction de Serban Ionescu, pp.383-421. Louis Crocq : Les mythes du trauma, in Confrontations Psychiatriques N°51, Psychotraumatismes majeurs. Serban Ionescu Traité de résilience assistée, préface de Boris Cyrulnik, PUF, 2011. Pierre Janet : Cours au Collège de France, L'évolution de la mémoire et de la notion du temps, 1928. L'Harmattan. Dominique Le Doujet : pour une revalorisation du corps : intimité, dignité et service à la personne. Presses de l’EHESP, Rennes, 2014. Pascal Pignol, thèse de doctorat : Le travail psychique de victime. Essai de psycho-victimologie, 2011. Jean-Pierre Vernant : L’univers, les dieux, les hommes, Seuil, 1999.
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The resilience manifestation in Reunion Island traditional environment Payet Sinaman F. Doctorante en psychologie clinique (France) Sous la direction du PR JF HAMON Université de la Réunion - CIRCI
[email protected]
Abstract The presentation is focus on resilience from the cultural point of view as express on Reunion Island. We adapt a phenomenology approach of resilience based on its three components: treatment, process and result. Out goal is to contribute to the theory of this phenomenon collectively described and presented by individuals of this society. The paper is based on a qualitative analysis of collective representations starting with popular writings. This analyse emphasises that resilience is part of a long continuum of struggling to resistance till spiritual transcendence. Ordinary language shows a way to face life challenges based on a socio historic traumatic past including slavery. The lexicology analysis shows a resilient type of personality, psyche-soma solidarity in the process of resilience and achieving a spiritual dimension as a sign of resilience as result. Key words: resilience, cultures, traditions societies, spirituality, language
Introduction Si la psychologie met l’accent sur l’histoire individuelle d’un sujet, Derrivois (2011) que « les ressources individuelles s’activent toujours sur fond de ressources collectives ». Dans le contexte traditionnel de la Réunion, on observe une omniprésence du religieux, du spirituel, d’un système de pensées complexes, des croyances persistantes dans la psyché individuelle et groupale et des pratiques cultuelles vivaces. Comment ces éléments interviennent-ils dans la construction de la résilience ? Quelles contributions la recherche en milieu traditionnel peut-elle apporter à l’enrichissement conceptuel de la résilience et à sa compréhension? Afin d’ obtenir une compréhension indigène dans une “configuration traditionnelle” (B.Champion, 2010), j’ ai adopté une démarche empirique à partir de la langue dans une visée exploratoire. Ce procédé se justifie par deux principaux obstacles .L’un d’ordre théorique concernant l’ambiguité conceptuelle de la résilience et l’autre méthodologique. Selon M.UNGAR (2010), l’appréhension de la résilience au niveau conceptuel est obscurcie par les influences contextuelles. D’autre part, poursuit cet auteur, l’approche étique a été privilégiée dans beaucoup d’études. Des biais ont été démontrés rendant problématiques voire contestables, certains résultats. Aussi, une voie possible consiste à envisager en complémentarité une perspective émique. Dans cette optique, partir de ce disent et pensent les personnes concernées, par l‘examen de la langue courante, notamment du lexique référentiel, est une piste pertinente. En effet, le lexique permet la création d’un rapport symbolique entre le locuteur et le monde. Mais également entre le locuteur et la société, la culture dans laquelle il vit. Son rôle est essentiel dans l’élaboration de la pensée, de l’identité de l’individu dans son milieu. J’ai effectué un repérage non exaustif des expressions, mots, locutions et des proverbes en usage dans la langue courante à partir de textes chantés populaires. Ceux- ci véhiculés au sein du grand public révèlent la représentation collective du mal être psychologique, du traumatisme et des moyens pour parvenir à les dépasser. Ils témoignent également des traces traumatiques profondes enfouies dans l’inconscient collectif. Ce choix se justifie par le souci d’une plus grande proximité avec la représentation collective traditionnelle accordée au bien être psychique, à un développement réussi. Le but étant de saisir un sens contextuel tel qu’il s’exprime dans une oralité conservée et non pas de rechercher la traduction du concept de résilience. Dans l’univers traditionnel réunionnais pour parler du développement, en Créole, un individu dit « mwin la grandi dedan » (littéralement, « j’ai grandi dedans ») pour signifier ce qui l’a façonné, fabriqué, ce qui l’habite et laisse voir sa vision du monde. Aussi, le mal être psychologique, les obstacles, les situations délétères, les traumatismes, les moyens pour les dépasser s’appréhendent avec une conception empreinte d’un sens religieux. Mon hypothèse est qu’en configuration traditionnelle, la résilience trait, processus et résultat s’inscrirait le long d’un continuum qui va d’une résistancelutte jusqu’ à une transcendance spirituelle. En complémentarité à l’analyse lexicale, afin d’appréhender cet
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éthos et d’éviter un biais ethnocentré, j’ai procédé à une analyse cognitivo discursive d’un discours émanant de plusieurs internautes à propos de la diffusion sur internet d’une cérémonie sacrée. Le problème posé à l’origine de cette discussion est la réaction controversée quant au dévoilement médiatique de ce type de rituel. Dans un premier temps je donnerai une brève présentation des données théoriques et méthodologiques en privilégiant la perspective culturelle. Puis, je présenterai la conception traditionnelle des trois composantes de la résilience (trait-processus et résultat) à travers l‘analyse lexicale qualitative issue des écrits populaires en y intégrant les résultats de l’ analyse du discours.
Considérations théoriques et méthodologiques L ‘île de la Réunion, située dans l’ Océan Indien, à sept cent kilomètres de la côte est de Madagascar réunit sur sa terre une variété d’habitants issus de son peuplement originel. De l’ interaction de ces peuples différentes, facilitée par une plurireligiosité, a fini par naitre, au fil des générations, une pensée sociale et religieuse spécifiquement réunionnaise, élaborée à partir des catégories communes appartenant à chaque système religieux” (F. DUMAS-CHAMPION, 2008).Différentes visions du monde se côtoient dans un contact permanent contribuant à vivifier et dynamiser l’ éthos culturel réunionnais. Discourir sur la résilience culturelle dans ce milieu revient à l’envisager dans une perspective plurielle, complexe en intégrant différents niveaux d’analyse. Les données de la littérature montrent qu’il existe au moins quatre voies possibles concernant les contributions que la recherche peut apporter quant aux relations entre culture et résilience. D’abord, l’étude des racines culturelles, les dispositifs traditionnels de soins, les sociétés soumises au stress et à l’acculturation des sociétés dominantes et enfin l ‘étude des facteurs culturels de protection IONESCU (2011), UNGAR (2010). Ces pistes de recherche récentes font partie de la quatrième vague d’études sur la résilience qui l’inscrivent dans une perspective culturelle. Brièvement, en psychologie, les trois vagues d’études antérieures ont sucessivement mis l‘accent sur la résilience comme trait, processus et résultat. De nombreuses interrogations demeurent au sujet de ce concept aussi bien au niveau théorique que méthodologique. Ainsi, M.UNGAR (2010) pointe l’un des obstacles important est la manière d’envisager la recherche sur la résilience et de l’évaluer rendent difficile la recherche empirique. En effet, étant un construit culture bound euro centré, il a été appliqué à d’autres contextes. (KAGITCIBASI, 2006 cité par UNGAR, 2010).D’autre part, un biais l‘affecte fortement: “l’attachement au discours scientifique objectif”. Cet auteur préconise alors l’étude des sociétés hors contexte occidental en l’envisageant dans une perspective écologique.
1.1 Conception traditionnelle de la résilience en milieu créole : la langue, support d’analyse du façonnage de la résilience. 1.1.1 Le lexique, premier niveau d’analyse Dans un contexte écologique traditionnel, il est pertinent d’envisager le renversement épistémologique proposé par DERRIVOIS (2011) qui postule « une résilience de l’Esprit et des esprits » soumettant ainsi ce concept dans la perspective d’un nouveau débat .En effet, les racines culturelles de la résilience à la Réunion puisent dans un éthos particulier fortement marqué de plurireligiosité. Comme le souligne BRANDIBAS (2003) « cette terre créole a façonné ses enfants, fabriqués avec des pensées, des mots, des histoires familiales, des cultures marquées par les ruptures et les traumatismes ». L’ile de la Réunion est passée successivement du statut de colonie, puis de département à Région française. Cette société s‘est construite dans la survie, la résistance, et la souffrance pour large majorité des habitants, chaque époque apportant son lot de difficultés. C ‘est dans cette configuration, qu’ est née le Créole réunionnais. Il s‘est crée et développé dans la nécessité d’un vivre ensemble soumise à la domination et à l’acculturation de la langue Française. Il a été tout à tour, interdit dans les espaces officiels, objet de lutte contre l‘indifférenciation et pour sa permanence. A présent, cette langue s‘écrit, est prise en compte dans l’enseignement, est source de créativité s‘exprimant sans complexe dans les écrits populaires. Aussi, je risque l’analogie en parlant d’une langue résiliente. 98% du lexique de la langue Créole est à base lexicale Française. Le Créole réunionnais a conservé et véhicule de nombreuses références à la spiritualité. J’ai effectué un relevé de certaines catégories verbales dans un corpus de textes chantés populaires, en puisant dans le répertoire du maloya (chant traditionnel sacré et/ou profane) et du dancehall, style musical moderne de la jeune génération. Ainsi, la manière d‘envisager une situation délétère détermine l’intensité et l’impact que cette situation aura sur l‘individu. De même que le locus de contrôle (ROTTER, 1954) reste prédictif dans la manière de vivre cette expérience. J’ai examiné la relation entre une situation délétère et le locus de contrôle. La grille d’ analyse élaborée à postériori détermine trois catégories: 1/ La première catégorie se subdivise en trois sous catégories: un impact sur le corps seul, un impact psychique uniquement et un impact affectant à la fois la psyché et le soma. Le locus de contrôle peut être interne et/ou externe.
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2/ Une deuxième catégorie dans laquelle la situation délétère induit l‘idée d’expiation, de châtiment. Cet évènement n ‘est pas généré par l’individu mais il est amené à vivre cette expérience car il doit en retirer une leçon. Le locus de contrôle est interne. 3/ La dernière catégorie se subdivise en deux sous catégories: situation délétère causée par des agents visibles (les humains) ou des agents invisibles (les esprits). L ‘évènement est un coup du sort relevant du destin. Le locus de contrôle est externe.
1.1.2 Le discours des sujets, deuxième niveau d’analyse J’ai effectué une analyse cognitivo discursive à l’aide de TROPES (P.MOLETTE, A.LANDRE, R. GHIGLIONE, 2013) d’un discours émanant d’un groupe d’internautes recueilli sur le site d’un journal électronique local1. Ce support permet une double distanciation : une mise à distance d’un dispositif expérimental physique et les biais relatifs. Puis, la production d’un discours plus ou moins authentique (non censuré) des sujets. Le discours est composé d’un total de 47 échanges. 3 sujets interviennent en plusieurs fois. Le style général du texte est argumentatif. 40 propositions remarquables ont été retenues ainsi que 8 épisodes détectés. Les mises en scène montrent que les internautes discutent, comparent et critiquent. Ils se passionnent (153 mots soit 34.3% pour les modélisateurs d’intensité) mais se mettent également à distance pour raisonner. Ainsi, le taux des adjectifs subjectifs 45.7% (79 mots) avoisine le taux des adjectifs objectifs 43.4% (75 mots) pour la totalité du discours. Leurs propos sont assumés et ils s’engagent personnellement dans la discussion. Le pronom dominant est le « je » (32.9%).On observe également le pronom « on » (15.8%) qui est concentré dans chaque épisode au début et/ou au milieu du discours mais tend à faiblir à la fin de discours. Basé sur des critères normatifs, un discours entendu, les sujets finissent par s’influencer mutuellement (modélisateurs la cause obtient 18.4%, l’opposition 16.3%) et se faire une propre opinion. On observe pour les modélisateurs 0.0% pour doute. Sur un total de 1013 verbes, les verbes statifs, exprimant des états ou des notions de possession obtiennent le score le plus élevé avec 405 mots (40%).
Discussion Traditionnellement, l’homme anthropomorphise tout. Il projette sur son milieu sa manière spécifique de dire son propre corps (BADGIONNI, 2002). A la Réunion, des catégories verbales spécifiques désignent des maux, des malaises, des maladies du corps. D’autres réfèrent au psychisme seul. Dans ce cas, la tête le symbolise, elle est synonyme d’esprit. L’individu est tourmenté et/ atteints de troubles psychiatriques. D’autres catégories encore expriment une solidarité soma-psyché. Ainsi, le corps peut désigner l’individu lui-même servir de barrière contre l’envahissement et/ou l’anéantissement psychique. Il symbolise la puissance « Kaf na sept peaux », « na la peau dyr 2» et a par analogie une fonction de protection du psychisme « l’esprit i vive dan le kor3 ». De cette analyse, on peut brosser le profil d’une personnalité résiliente. L’individu a un « lespri for » (une force mentale), “un for tampéraman” (BRANDIBAS, 2003).A l’opposé, un vulnérable a “lespri feb” (une faiblesse de caractère). Le résilient possède un mental d’ acier (“lé rézistan”), une force spirituelle propre ( “na un gayar”,”lé kador”, “na tét dyr”) .Il est sage et un devoir d’aide. Il cumule les caractéritiques théoriques de la “personnalité hardie” telle conçue par leurs auteurs (KOBASA et MADI, 1977).Il s’agit d’une caractéritique de “la personnalité se rapportant à des croyances, des sentiments, des valeurs qui s’expriment par une constellation de trois dimensions inter reliées, soit, le sens de l’engagement, le sens de la maîtrise, et le sens du défi”. Ce Type d’ individu est un “zarboutan”4, il est fiable, fonctionne comme un garant. Le locus de contrôle de cette personnalité est interne. Face à une situation délétère, la première attitude d’une personne est qu’elle « pran son problème », De nombreuses références sont associées à la main. Faut-il y voir la trace dans l’inconscient collectif de cet outil majeur de survie dans l’ancien temps ? Une fois la situation empoignée, on la rend solidaire du corps, médium indispensable : « i tienbo ansamb », « i larg (lach) pa lo kor », « i rézist »5. Le sujet pour aller mieux, doit « batay », « sobat » « lyter »6. Ce processus est une lutte- résistance. Ceci se traduit par un mouvement physique car si l‘engagement est d’ abord physique, celui-ci conditionne le mental, on « mange ou on port la douleur » (manger ou porter la douleur) pour se lever et se mettre debout. Ce processus est graduel car on sait que c’est « ti
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Article du 08/12/2009 : “on appelle les esprits pour protéger la famille”, site du journal zinfos 974 Expression signifiant littéralement « le Cafre a sept peaux ». Le cafre désigne à la fois les descendants des Malgaches et d’Africains. 3 Signifie: l’ esprit habite le corps. 4 Ce terme designe les vieux artistes qui ont milité pour la reconnaissance et la sauvegarde du maloya, la musique traditionnelle de la Réunion. Ce sont des figures emblématiques et ont un rôle d’ ainé et de guide. 5 Signifie successivement « tenir ensemble » et « ne pas lâcher le corps » « résister ». 6 Dans ce contexte, tout le champ lexical de la lutte et du combat peut être évoqué. 2
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The Second World Congress on Resilience: From Person to Society (Timisoara - Romania, 8-10 May 2014) pa ti pa », « ti lamp ti lamp »7 qu’on s’en sort. L’espoir et la foi en soi sont sous jacents à ce processus. Il existe beaucoup de proverbes dans la langue Créole enseignant l’acceptation et la patience comme facteurs de protection. Pour marquer la fin de cette lutte- résistance et désigner le recouvrement après une expérience délétère, des catégories verbales traduisent le retour à un nouvel état. On dit d’un sujet, que « li la ensort a li » ou « li lé bien koméla »8.Cette personne s’est dégagée d’un problème antérieur, le résultat est manifeste. Ainsi, « li lé libéré » (il est libéré), « li la levé » (il est debout) et peut continuer son cheminement. Certains mots et locutions évoquent aussi, au bout de ce parcours de lutte, l’idée d’une métamorphose, d’une transformation comme dans « li la refé ». Autrement dit, il devenu autre. Bien souvent, c’est suite à une nouvelle affiliation ou ré affiliation au sein d’un groupe culturel donné ou une rencontre spirituelle que cette transformation a lieu. Le résultat est une élévation de l’âme9. A la Réunion, les réalités existentielles s’interprétent dans une perspective baignant dans le mysticisme chrétien et/ou animiste. Les thèmes qui ont une forte occurence sont la famille, la religion, la tradition, le groupe social, les sentiments, la mort et le temps. Les valeurs traditionnelles, comme le respect des pratiques ancestrales des uns et des autres, le respect des aînés, des morts, la tolérance, la recherche de spiritualité imprégnent fortement ce discours. Selon Dumas-Champion (2008), dans le contexte réunionnais l‘interprétation des maladies sert de base pour penser le religieux en général.
Conclusion Cet exposé avait pour objectif de montrer qu’ au delà des débats entourant la résilience, les obstacles d’ordre méthodologiques et théoriques peuvent s’aplanir. Des précautions doivent cependant être prises. Les effets contextuels sont puissants, il est difficile de les ignorer. D’autre part, se focaliser sur ce qu’ UNGAR (2010) appelle “l’ attachement au discours théorique objectif” constitue une entrave supplémentaire à l ‘appréhension de ce concept. Une voie alternative reste la recherche empirique et une méthodologie créative et mixte. Dans la configuration traditionnelle étudiée ici, le phénomène se conçoit dans un cadre autorisant un saut épistémologique préconisant une résilience de l’ Esprit (DERIVOIS, 2011).La résilience s‘exprime dans une langue concrète, imagée mais qui soutient une pensée, une vision du monde complexe, multi et trans culturelle. Dès lors les caractéristiques individuelles ne peuvent être étudiées sans le processus qui a permis à un sujet dont l’identité culturelle est fortement subordonnée à son affiliation à un groupe déterminé. Celui-ci lui offre l ‘étayage en cas de nécessité. Il peut acceder à d’ autres groupes pour trouver son bien être et continuer à se développer. De sorte que le résultat issu de cette quête devient à son tour dépendant des deux autres éléments. L’ atteinte d’une spiritualité signe le résultat de la résilience. L’analyse des écrits populaires montre une évolution et une différence dans l’esprit véhiculé dans la représentation collective. Autant le traditionnel emploie un langage de résistance, de lutte et de survie, autant la jeune génération s’exprime, clame de ne pas céder aux difficultés, de cultiver l’espoir, de s’élever, et croire en une divinité, prône la conscience collective et l’unité tout en conservant la multiplicité.
References [1] [2] [3] [4] [5] [6] [7] [8] [9]
Derivois, D. (2011). L’hypothèse d'une résilience de l'Esprit et des esprits en Haïti. Sciences-Croisées Numéro 11 : Souci de soi – souci de l'autre. Champion, B. (2010) Religions populaires et nouveaux syncrétismes. Surya Editions. Réunion. Ungar, M. (2010). Handbook of adult resilience. Edited by John W. Reich, Alex J. Zautra, John Stuart Hall, pp 404-423 Dumas-Champion, F. (2008). Le mariage des cultures à l’île de la Réunion, éditions Karthala Pourchez, L. (2005). Métissages à La Réunion: entre souillure et complexité culturelle. Africultures, Le site et la revue des cultures africaines. Ionescu, S. (2011). Traité de résilience assistée.PUF. Paris. Brandibas, J. ; Gruchet G. ; Reignier P. (2003).Institutions et cultures. Les enjeux d’une rencontre. L’harmattan. Molette, P. ; Landré, A. ; Ghiglione, R. (version mai 2013). Logiciel Tropes. Baggioni, D. (2002).Le corps: son lexique, son langage et sa symbolique en Créole réunionnais. Un état des savoirs à la Réunion. pp17-20
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Les deux expressions signifient “petit à petit” Signifie : « il s’en est sorti », « il va bien à présent ». 9 A noter que les références lexicales signalant la transcendance spirituelle, le recours à Dieu sont très nombreuses. 8
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Narrative constructs of resilience in post-apartheid South Africa Rogobete I.1, Rogobete S.2 1
Areopagus Institute of Family Therapy and Systemic Practice (ROMANIA) West University of Timisoara (ROMANIA)
[email protected],
[email protected] 2
Abstract The concept of resilience is a multidimensional construct which has been defined in various ways and from multiple perspectives. A common element to most conceptualisations is represented by the adverse context in which resilience can be developed. This paper aims to identify specific constructs of resilience used by survivors of political violence in their narratives of recovery after serious trauma. The study adopted a thematic narrative analysis of twenty life narratives, taking into consideration the use of language, structure, sequence of events, chronology, plot and the meaning participants ascribed to various experiences. Results showed that stories of resilience have specific characteristics in terms of structure, language and content compared to stories of non-resilience. The analysis highlighted the following constructs of resilience: defining the self as survivor, fighter and hero, purpose and commitment towards fulfilling a goal, ability to access internal and external resources, healthy relationships and meaningful engagement with the social world. Keywords: Resilience, narratives, self, thematic narrative analysis, post-apartheid, political violence
Introduction The psychological impact of political violence during apartheid in South Africa has been extensively analysed through research, conceptual analyses and discussions during various academic events. Numerous research studies have emphasised the traumatic nature of political repression which had a negative impact on the Black and White population who were actively involved in the struggle against the oppressive regime. [1] [2] [3] [4] After the collapse of apartheid, former victims of political violence started to embark on a journey to psychological, relational, social and economic recovery. As expected, their experiences of the recovery process have been rather different. Some were able to rebuild their lives, developing resilience and even growth as a result of their traumatic experience. Others, on the contrary, were not able to make much progress as their continuous suffering increased their sense of helplessness and bitterness. Several research studies have pointed out that a majority of survivors of gross human rights violations during apartheid have become more resilient as a result of their trauma. [3] [4] [5] The research methodology employed by researchers to analyse life trajectories in the aftermath of trauma used a combination of methods (quantitative, qualitative and mixed) in order to create space for more complex interpretations in the process of analysis. As part of the qualitative methods, it is commonly acknowledged that life narratives represent insightful ways through which one can gain a better understanding of the story teller’s reality. [6] Regarding research in the field of psychology, narratives are usually used in the form of “extended accounts of lives in context that developed over the course of single or multiple research interviews of therapeutic conversations”.[7] The political and cultural context shapes the narratives of individuals and groups in society. Narratives of war, genocide, mass-killings and refugees cannot be understood in the absence of a historical and political framework. Most studies on trauma and recovery processes have worked with life narratives of suffering, conflict and healing. [8] In her book on narrative inquiry, Reissman identified specific elements and functions of narrative analysis, which are at the core of this research method. An important feature of narrative is its constructive and performative character. [9] Narratives do not convey unmediated facts and events since they rely fundamentally on language, memory, interpretation and human subjectivity. Consequently, narratives are not simple reconstructions of empirical past events, but ways in which past events are used by people in the present to make sense of their experiences and construct their individual and collective identities. [10] Narratives are part of the collective through the way protagonists shape their stories and use language. According to Antze & Lambeck (1996), narratives also contribute to the construction of collective experience and meaning in the present. [11]
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The significant link between narratives and the self is emphasised by Paul Ricoeur (1992) in his book Oneself as Another. [12] He argues that people define themselves as being distinct from others through a continuous narrative process in which past and present events are organised into actions, motives and situations. [11] People construct identities through their stories, which fulfil multiple functions in the process. Riessman showed how narratives serve various purposes depending on who the speakers and the audience are. [7] For example groups and communities make use of narratives to mobilize masses into action, to protest against injustice and to contribute to positive social change. Narratives operate in a linguistic universe in which structures of language confer coherence, order and meaning to representations of events, experiences, characters and actions. Although language is the vehicle of representations in narrative structures, the meaning of events is not restricted by inflexible linguistic boundaries. In this vein, Scott argues that “experience is a linguistic event (it doesn’t happen outside established meanings), but neither is it confined to a fixed order of meaning. Since discourse is by definition shared, experience is collective as well as individual”. [13] Therefore, such characteristics of life narratives are relevant for the analysis of resilient processes that might be present in survivors’ stories included in this study. As a theoretical framework for conceptualizing resilience, Ungar’s (2008) [14] model seems to be more complex and holistic than previous approaches [15], [16], [17], as it takes into consideration both individual and contextual aspects. These are reflected in the following dimensions: (1) access to material resources (personal agency, self-esteem), (2) relationships, (3) identity, (4) power and control, (5) cultural adherence, (6) social justice and (7) cohesion. [14]
Methodology This analysis is part of a more complex research study that took place at the University of Cape Town in South Africa, during 2008-2011. [18] The study sample included twenty survivors of gross human rights violations who suffered: detention, torture, police harassment, displacement, shootings, or the loss of a significant other. Interviews were conducted during 2009 - 2010, involving participants from a diversity of race groups, ages, gender and socio-economic status. General areas of exploration were: (hi)story of suffering under apartheid, impact of traumatic events, ways of coping with negative effects, helpful and hindering aspects of their journey after trauma, present situation and views about the future. Interviews were recorded and transcribed for analysis. The study used qualitative research methods and thematic narrative analysis. The conceptual framework of the study was informed by contextual and narrative approaches to understanding trauma and recovery. Moving beyond a mere medical approach, the analysis highlighted complex articulations of trauma reconstructions and multiple pathways to recovery which emphasise resilient life trajectories.
Results and Discussion Silverman suggests that while performing the narrative analysis, researchers should move beyond their data in order to find explanations. This means to move from “commonplace observations to a social science analysis” [6]. It is also what Braun and Clark (2006) defined as a search for latent meanings, a process considered to be more than a mere description of phenomena. Important questions to bear in mind at this stage would be: “What is the purpose of participants’ descriptions in this study and what are their intentions in structuring their stories in a certain form?” and “What is the meaning of these stories and why are people telling these stories?” [19] By examining survivors’ narratives with a focus on these particular questions, the analysis process was able to access new and multiple levels of meaning in which social expectations, cultural values, language structures and identity constructs interact in sophisticated ways to shape the structure and meaning of narratives. Observing closely the life trajectories of survivors, clear differences were distinguished in the area of survivors’ journeys after trauma up to the present time. Some narratives follow progressive pathways while others, on the contrary, show stagnation and regression which may point towards a condition of continuous traumatic stress following previous experiences of trauma. [20] Participants actively use language structures and metaphors to interpret and construct various meanings about their selves and the world in which they live. Thus, some participants in this study reconstruct themselves as survivors, heroes, successful, able to cope with challenges, resilient and in control of life events. Others, on the contrary, describe themselves still as victims, helpless, angry, bitter, defeated and disillusioned. The next section will discuss some of these features comparatively.
1.1
Two polarised worlds: narratives of resilience and helplessness
The use of language in the form of passive or active verbs, the use of personal pronouns as well as metaphors and symbols suggest a means for understanding intention and meaning in narratives [6] [7]. For example, in resilient stories, one can easily notice the extensive use of the “I” pronoun, active verbs and detailed descriptions about achievements and personal efforts. Such stories do not talk to a great extent about trauma and
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its psychological impact, but rather describe positive coping mechanisms and how survivors succeeded in overcoming the negative effects. Through the construction of these stories, the self emerges as being in control of his/her life, as an agent of change and being engaged with social realities. In the following quote, on only one page of transcript, the pronoun “I” is used over 50 times and the pronoun “my” 26 times. The paragraph shows how the language shapes the narrative form: And so this great fear almost apprehended you and these things welled up on the inside and I needed to deal with those things because I couldn’t allow my greatest fear to restrict what I thought I needed in order to make a contribution. And so in dealing with this I needed to create within myself the opportunity to explore and internalise this great hope that whatever I went through had an expiry date. That is, it will end. That was my greatest hope. I just couldn’t determine when it would end. But this hope was inside of me and so part of my answer to the solution was my hope. Hope is a fickle thing and very often disappoints you. Because of the struggles that I went through and the fact that I was born out of struggle as it were, I felt I had endured enough struggles to be able to carry on hoping this would be better. And I said to myself: this was only a transitory phase in my life. I am destined for greater things. That is what kept me alive, that is how I kept sane amidst all the insanity (P1). The quote shows how the use of active verbs (deal with, create, explore, internalise, determine, endure) and metaphors (“I was born out of struggle”) create the idea of agency and control, which are important elements of progressive narratives. In addition, resilient narratives are more elaborate and descriptive, using a variety of language structures and vocabulary. One can feel that the narrator has a voice and something important to tell. [21] On the contrary, the majority of Black participants who still live in townships and continue to struggle with poverty, unemployment, illness and crime have used a different type of language structure. They also considered it more important to talk about their past, their suffering under the apartheid and the impact of their sacrifice for the good cause. [22] They expanded on the impact that multiple types of trauma had on themselves as individuals as well as on their families and communities in which they lived. Their language reflects extensive use of verbs used passively (taken, put, beaten, carried) and of the pronoun “they”. They caught me and put chains around my legs. I was full of blood on my face. They threw me in the back of the van and took me to John Vester Square in Joburg at the 10th floor, room 1026. They tortured me, beating me and asking me all sorts of questions. They put a handkerchief in my mouth, cover my mouth with a plaster, put my hands at the back with handcuffs and they chained my legs. Then they covered my head with a wet bag. While I was struggling breathing they electrocuted me. I don´t know how many times. When they cool it out, I was very numb… (P2) Participants make extensive use of metaphors in their stories. This is highly visible, especially when they try to reconstruct their pain and negative feelings. Metaphors, comparisons and personifications become useful tools in participants’ attempt to find the right language to describe their suffering. For example, one survivor (P5) describes herself in the light of past and current victimisation through a powerful metaphor: “I’m a vandalised person by the apartheid”. Another participant (P7) describes himself in the present as a “mental wreck”, “a laughing stock” and “a joke”. Similarly, when talking about his recovery after trauma with regard to his family, one participant (P12) concludes: “We cannot be recovered… we are just mingling around in mist”. In addition, when talking about current attitudes of people in black communities, one participant used a powerful comparison: “It is such a sense of poverty and our people is nesting it like a baby. Poverty is their baby. They should say, no! Go out! Don’t stay with me! You are not my friend! I’m fighting with you! You are the devil!” All these elements point towards what Silverman termed the puzzle, arguing that it has to be assembled piece by piece in the process of analysis. [6] A major task at this stage was to find explanations for the intention behind the use of language in the narratives. Within this context, Silverman’s indication is to search for data outside the confines of the study. Therefore, we complemented existing information with findings from similar and broader social contexts by searching deeper with regard to the moral and cultural worlds of the two types of narratives, whose protagonists were former victims of repressive structures of apartheid. On the one side, it was the universe of those who “have made it” or who “are climbing the mountain” and are at various levels of height. On the other side are those who “are still struggling” or have not made much progress in climbing the mountain. The metaphor can go on with regard to why the second category of people were not able to climb the mountain, whether because of lack of the right equipment (education and personal resources) or fear of difficulties (lack of skills and social support) or because of trying to find an easier way around the mountain (avoidance/passivity). However, although such presuppositions may carry with them some psychological truth, there is a need for a more profound analysis and interpretation both in the context of the study’s further findings and previous theoretical concepts.
1.2
Dimensions of resilience in post-apartheid
A common element of resilient life trajectories is the success and achievements experienced by survivors throughout their lives after trauma. Considered by various researchers as positive outcomes in the
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process of recovery and development of resilience, such constructs represent important elements in survivors’ journey of defining meaning of their selves and the world in which they live. [23] There is clear evidence that participants in this category define themselves in positive terms. They display their identities emphasising their strengths, success and achievements, situating themselves in contrast with people who do not possess such qualities. They seem fully aware of the victimising connotation inferred through the victim label and prefer to call themselves survivors instead of victims (I am very strong, I’m a survivor, I can take anything! I helped many people. Other people become morbid, depressed, depending on tablets to make them sleep, tablets to wake them up. I’m not that way, I’m not that way! I find means of getting stronger because my faith is strong and I won’t allow anybody to diminish my mind. Most of the time, I try my best to be the person that I am. P5) One of the most important aspects regarding the ways in which participants in this category rebuilt their selves concerns the development of constructive coping skills. An important role in this process was played by an individual’s ability to access internal and external resources and to pursue higher goals. Personal qualities and talent were considered by survivors an important resource in dealing with the impact of trauma and a way of creating new meanings in life. These attributes together with positive perceptions about the self have been considered important elements in the construction of resilience and posttraumatic growth. [24] [14] As was observed in people’s narratives, the way to developing good coping has been paved with great effort and mixed feelings. For example, one survivor expressed the struggle, loneliness and confusion she experienced in the process of finding meaning. Art became her “escape” and “shelter”: You can be alone in the fight because you cannot express yourself, sometimes you don’t know what you really want and you try to find what you really want. My art became an escape, it gave me shelter. I didn’t have good schooling, good academic skills. I dropped out of school but I always felt there was nothing I could do without having good education, good family structures. I can give to other people. I felt I had that gift that I can give to other people. (P18) Her words clearly show how the self is rebuilt and paradoxically enriched by giving to others, a fact that supports the relational dimension of the self. [12] [25] Another important step for participants in developing good coping skills was to refuse passivity and victimisation (“I was not given many opportunities, but (…) I was not going to blame the legacy of apartheid or to be marginalised.” P 11). Pursuing and fulfilling goals (not only setting goals) was also mentioned by most participants as an important aspect of their successful life trajectories (“I was going to pursue this at whatever cost. I have already pursued other things in my life and the cost was nearly my life. So, why would I now hold back on my life in terms of shaping direction?”) In defining coping strategies, resilient participants expressed several beliefs: (1) good decisions have to be followed by actions (“when I make up my mind about something then I go all out for it”), (2) there are important lessons that can be learnt from mistakes (“I see failure as a growth process”), (3) one needs to assume risks in life (“If I hadn’t taken the risk, I wouldn’t have accomplished what I needed to accomplish”) and (4) failure is not an end but “another stepping stone towards getting to where I needed to go”. According to Bonano’s (2004) theory of resilience, these characteristics describe hardiness - a concept considered to be one of the “multiple and sometimes unexpected pathways to resilience”. [26] Last but not least, the anchoring of the self on religion and faith appeared to be a constant element in the struggle against the destructive legacy of the totalitarian political context of apartheid. Religion and religious beliefs, as fundamental markers of identity, can offer solid ground for building resilience in times of political crisis and conflicts. [27] As one survivor mentioned: “I think it has everything to do with my faith that I have. I strongly believe that we are a purpose-driven creation”. For him, the spiritual dimension is not just another facet of the self but rather the transcendental framework in which all the other dimensions of the self (as caring, loving, capable, successful and forgiving) make sense and are able to draw their energy from. In terms of perceptions about current contextual realities, most participants emphasised the importance of continuously engaging with the context in which one lives by assuming responsibility in relating to others and defining the social context. One participant perceived it as a daily struggle as “dealing with people in the world, there will always be things taking you back in that situation. Each time when you wake up you have to say: Ok, I’m going out in the world today and I don’t know what is gonna come. Today I don’t know who I am going to meet”. However, social change in the context of transition depends on multiple interacting factors. The intersection between identity, race and economic inequality is evident in participants’ perceptions of current contextual concerns. Finally, being engaged in the social context did not mean only expressing positive views but also openly addressing issues of social concern. The slow change regarding the issue of poor housing conditions in black communities made one survivor affirm that “apartheid is still there, townships are still there. If the ANC will be sincere, they will do something about townships, try to put people together…” Being disappointed with the current economic and political situation is arguably understandable in the context of participants’ personal investment and traumatic experiences in the struggle against apartheid. One the one hand, this aspect supports Crossley’s (2000) idea of the self as being constructed through “historical and social structure”. [28] On the
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other hand, it highlights Taylor’s (1989) concept of a “moral universe” as a context in which the self reflectively makes sense of what is “good” through responsible engagement with the world. [25]
Conclusions Summing up the main findings of the narrative analysis, one can easily notice that resilient life trajectories have distinct characteristics compared to non-resilient stories of recovery. Taking into consideration the structure, language, tone, content and meaning of the narratives, it can be assessed that resilient stories convey more agency (through the use of active verbs and the pronoun “I”), are more present and future oriented, have a more optimistic tone and are more concerned with the rebuilding process than with the damage caused by traumatic events. The multiple ways in which survivors have developed resilience in their journey to recovery were related to various aspects such as good coping skills, agency and control, positive self-concepts, healthy relationships with others, spiritual development and active engagement in communities. This situation confirms Bonano’s (2005) statement that resilience is more common than is often believed and that it can be achieved through multiple pathways. [26] Furthermore, resilient narratives celebrate the success and ability of individuals, families and communities to repair what trauma had destroyed in their lives. Obstacles are seen not as failures but as important lessons for the future. However, resilience is not an end in itself but a continuous process of making meaning and rebuilding oneself, others and communities. Since its rebirth after the collapse of apartheid, the rainbow nation of South Africa is continuously learning to develop resilience, growth and transformation.
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20]
Foster, D. & Sandler, D. (1985). A study of detention and torture in South Africa. Preliminary report. Institute of Criminology: University of Cape Town. Skinner, D. (1998). Apartheid’s violent legacy: A report on trauma in the Western Cape. Cape Town: The Trauma Centre for Victims of Violence and Torture. Straker, G. (1992). Faces in the revolution: The psychological effects of violence on township youth in South Africa. Cape Town: David Philip. Manganyi, N. C. & du Toit, A. (Eds.). (1990). Political violence and the struggle in South Africa. Hampshire: Macmillan. Marks, M. (2001). Young warriors: Youth, politics, identity and violence in South Africa. Johannesburg: University of Witwatersrand. Silverman, D. (Ed.). (2010). Doing qualitative research: A practical handbook (3rd edition). London: Sage. Riessman, C. K. (2008). Narrative methods for the human sciences. Los Angeles: Sage, p.6. Rogobete, I. & Foster, D. (2013). Text and context : The role of narratives and healing relationships in developing resilience. In Rogobete, I & Neagoe, A. (Eds.). (2013). Contemporary Issues facing families: An interdisciplinary dialogue, pp. 63-80. Bonn: Culture and Science Publishing. Abell, J., Stokoe, E. H. & Billing, M. (2000). Narrative and discursive (re)construction of events. In M. Andrews, S. D. Sclater, C. Squire & A. Trecher (Eds.). Lines of narrative: Psychosocial perspectives (pp. 180-192). London: Routledge. Shotter, J. and Gergen, K. (Eds.) (1989). Texts of identity. London: Sage. Antze, P. & Lambeck, M. (Eds.). (1996). Tense past: Cultural essays in trauma and memory. New York: Routledge. Ricoeur, P. (1992). Oneself as another. University of Chicago Press. In Riessman, C. K. (2008), p. 34. Ungar, M. (2008). Resilience across cultures. British Journal of Social Work, 38, 218-235. Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance to psychiatric disorder. British Journal of Psychiatry, 147, 598-611. Garmezy, N. (1991). Resilience in children’s adaptation to negative life events and stressed environments. Paediatrics, 20, 459-466. Luthar, S., Cichetti, D. & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543-562. Rogobete, I. (2011). Reconstructing trauma and recovery: Life narratives of survivors of political violence during apartheid in South Africa. Unpublished doctoral dissertation. University of Cape Town. Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101. Kaminer, D. & Eagle, G. (2010). Traumatic stress in South Africa. Johannesburg: Wits University Press.
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[21] [22] [23] [24] [25] [26] [27] [28]
Frank, A. (1995). The wounded storyteller. Chicago: The University of Chicago Press. Rogobete, I. (2013). Legacies of repressive regimes : Life trajectories in the aftermath of political trauma. In P. Runcan, M. Rata & A. Gavreliuc (Eds.). Applied social sciences: Psychology, physical education and social medicine (pp. 83-90). Cambridge Scholars Publishing. Rogobete, I. (2012). Searching for meaning: Recovery and growth in the aftermath of trauma. In Neagoe, A. (Ed.). Counselling and spirituality in the helping professions (pp. 37-51). Bonn: Culture and Science Publishing. Tedeschi, R. G. & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage. Taylor, C. (1989). Sources of the self: The Making of the modern self. Cambridge University Press. Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, p. 25. Rogobete, S. (2011). The interplay of ethnic and religious identities in Europe: A possible mapping of a complex territory. In E. Eynikel & A. Ziaka (Eds.). Religion and conflict: Essays on the origins of religious conflicts and resolution approaches (pp. 259-277). London: Harptree. Crossley, M. (2000). Introducing narrative psychology: Self, trauma and the construction of meaning. Buckingham: Open University Press, p. 21.
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Organizational resilience in the mining industry within the Valea Jiului communities Anghel M.E.1, Ştefănescu Marius V.2 1
Faculty of Sociology and Psychology, University of Petroșani, Romania Faculty of Sociology and Psychology, West University of Timişoara, Romania
[email protected],
[email protected] 2
Abstract The paper discusses aspects referring to the organizational resilience in the mining field within the Valea Jiului area. The restructuring of the mining sector, following the institutional reformation undergone by Romania during the transition period, entails a rethinking of the mining field, in order for the actors involved in the resilience process to assimilate new action models. The complex problematic of the social and economic reality in the Valea Jiului area has aggravated the decline of the area in all areas of life. This entails a sociological approach that underlines the understanding of the interaction between the institutional subsystems, when the decline of one of them generates a dysfunction in the other interposed subsystems. The paper focuses on analyzing the social and demographical tendencies, the strategies and the social and professional behaviours in the Valea Jiului area, as adaptive means through which people perceive and overcome certain structural changes, in the context of post-December institutional and organizational reformation. The presentation of such tendencies is objectively supported by the evidence of statistic data recorded during 1990-2011 and reflected on a subjective level in the perception, attitude towards or assessment of the problem studied. In this context, that of a difficult social and economic period, such as the current one, organizational resilience plays an important role in the institutional recovery process conducted within the Valea Jiului area, which will lead to a revitalization plan for the area. The importance of social knowledge is given by the outlining of the major tendencies that support adaptation and the drafting of sectorial policies and strategies that would correspond to the current local social and economic realities, as well as that would generate the desired effects. These have to be harmonized and correlated with the existent regional and national policies and strategies, by sketching the priority problems and their degree of social utility. Key words: resilience of organizations in the mining industry, contemporary economic and social crisis, institutional restructuring and adaptation, organizational sociology.
Introduction In our paper, we have tried to approach aspects referring to the organizational resilience in the mining field within the Valea Jiului area, from the perspective of the restructuring of the mining field, as a result of the institutional reformation undergone by Romania in the post-December period. This has entailed a rethinking of the sector, in order for the actors involved in lead resilience to assimilate new action models. This study is based on the perception the employees from the institutional mining system in the Valea Jiului area have on the institutional and organizational capacity to adapt to the post ’89 social, economic and political changes. The problematic of an ample transformation of the old centralized economic system into a functional market economy, following 1990, marks the beginning of a long and difficult road that has led to important mutations within all the aspects of the economic and social life, the knowledge of the economic and social reality becoming an essential factor and requiring the joint participation of specialists in interdisciplinary fields: sociology, economy, anthropology, history, demography, as well as other branches of science. Institutional fluidity (therefore the absence of institutional crystallization) and institutional rarity are the first characteristics of the macro-social transition space. [7] The institutionalization processes initiated during the first transaction years have targeted especially the social “periphery”, meaning the areas in which social complexity could be reduced through simple mechanisms. Taking into account the complexity of the processes and the phenomena, determined by the multitude of features and characteristics of these organizational mutations, there is the need of a deeper knowledge of the resources involved and of the effects generated by the activity analyzed. At the same time, it must allow for the objective selection of the most efficient manner to adapt to the new organizational structures. [8] According to the
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field literature, it has been deemed that the manner in which public organizations can be made more efficient is by being taken over by private management. [4] Management is a set of beliefs and practices developed within organizations as a strategy for improving performances. As Peter Drucker used to say, “managers and management make institutions perform”. The analysis of the institutional process as a system leads to identifying certain qualitative characteristics, because institutional reorganization, through the dynamics of the restructuring operated on an institutional level aims to make the institutional system more flexible and more efficient. Due to its nature, the process of institutional reformation accomplishes a function of structural adaptation to the European requirements. As a system for the extraction and processing of mineral resources, dimensioned from the point of view of material and human resources, according to the efficiency objectives and criteria, the production process fulfils the economic function. At the same time, as a form of social work, and as a place in which human personality is moulded, it also fulfils a social and human function. In this meaning, Peter Drucker says that the social reasons have priority, because the institutions are born to serve individual and collective interests of the collectivity, and not the other way around. From the point of view of this process of constant adaptation of the mining units to the market requirements, institutional reorganization plays an important role in the organizational resilience within the Valea Jiului area. The optimization of the institutional system, from the point of view of the mining activity, is the fundamental element for creating new work places, both within the system, as well as within other interdependent ones, and can generate, in turn, a regeneration of the regional social space. The adequate and efficient usage of work force in reasonable economic and social conditions, entail that the division of work, the expansion of the professional profile and of service areas be conducted in adequate development conditions or be based on the Valea Jiului area’s capacity of institutional recovery, because the complex problematic of the social and economic reality in the Valea Jiului area has aggravated the decline of the area in all areas of life. This situation entails a sociological approach that underlines the understanding of the interaction between the institutional sub-systems, when the decline of one of them generates a dysfunction in the other interposed subsystems. Taking all of the above into consideration, this paper aims to study the organizational resilience in the mining sector of the Valea Jiului area, by analyzing the perception of the employees of the mining units within the Valea Jiului area. The capacity to adapt to the new conditions within the mining sector in the area contributes to the development process of the area, and is at the same time a factor of economic and social balance of the area.
The research methodology This paper lists several aspects related to the results obtained, following the research conducted within my doctoral thesis entitled “Institutional birth rate and death rate – a sociological perspective on mining”. A social inquiry was conducted, having as its research tool the questionnaire, applied within the National Pit Coal Society of Petroşani (SNH). Both elements related to the objective situation of the mining unit, correlated with the local social and demographical tendencies, as well as aspects related to the subjective state of the employees within SNH, as well as subordinated units were subjected to social analysis, in order to outline an image as faithful as possible to the current 2013 reality of the mining sector within the Valea Jiului area, as a fundamental activity in the area. Taking into account the high number of employees (5,166), it was necessary to resort to a pool that would faithfully reproduce the shares held by the following variables: the mining units subordinated to SNH and the gender structure. As a pool scheme, we have opted for the “share” pool. The volume of the pool was 5% of the total population, which has led to a pool of 258 employees, and after rounding it up where necessary we have reached a pool volume of 273 subjects. The distribution of the subjects according to mining units was as follows: “EH Lupeni” (29.30%) followed by EH Lonea (21.25%), EH Livezeni (20.88%) and EH Vulcan (15.38%). For the other three units, the percentages are significantly lower, and put together they barely exceed 10%. Due to the fact that mining is a difficult activity that entails effort and physical force, meant mainly for men, we found that the male gender has the largest share (80.22%).
The subjects’ assessment of the changes occurred within the mining sector The social and economic effects of the restructuring process occurred within the mining sector have been felt strongly by the population in the area and require well-elaborated social measures in order to create a favourable context, needed in order to develop the business environment and a competitive economic spirit that would entail a favourable perspective for the development of a functional market economy, in order to elaborate a viable decisional alternative on the optimization of the social and economic structures within the Valea Jiului area.
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The evolution of the mining sector within the Valea Jiului area, throughout time, has known an ascension prior to 1990, generating a significant increase of population in the area, due to the migration of the work force from more or less surrounding areas. The policies promoted before 1989 gave birth to the development of an oversized mono-industrial centre, with a concentration of mono-qualified work force dependent at the same time on the evolution of the mining activity within the area. Within the context of national political, economic and social changes, the post-December period is characterized by an obvious downfall of this economic sector. The transition period has generated, among the population, the uncertainty of a work place, thus conditioning the withdrawal of a significant mass of population from this activity. This situation was even more inevitable in the Valea Jiului area, because this area was included in the national program for restructuring and orienting the industrialized areas towards an economically competitive market. An overview of the average number of employees shows that this remains relatively constant during 1991 – 1996 and then decreases significantly during 1997 – 1999, due to the restructuring of the mining activity, in each of the localities within the Valea Jiului area. After 1999, the average number of employees remains relatively constant, until 2011, except for Petroşani. As of 1997, the average number of employees decreases by 45% during a period of time of only 3 years. This decrease is explained through the layoffs occurred in the mining sector during that period, and by the fact that the extractive industry plays a primordial role within the entire industry of the Valea Jiului area. From 1999 to 2008, the number of employees remains constant, and following 2008, it begins to decrease again due to the onset of the economic crisis. In the Valea Jiului area, the average number of employees has decreased from 71,217 employees in 1991 to 28,448 în 2011. Therefore, within 20 years, the number of employees in the area has decreased by 42,769 employees. The results obtained following the sociologic inquiry conducted on the employees of the National Pit Coal Society shows the subjective side of the institutional mining system within the Valea Jiului area. The main aspects observed by the research, as a result of the institutional reformation, focus on the subjects’ opinion regarding the causes that led to the restructuring of the mining sector and the current situation of the mining sector, as well as an evaluation of the measures related to the personnel layoffs and the institutional reorganizations conducted. We have also touched upon aspects related to the perception of the subjects on the institutional future of affiliations within the energetic complex envisaged, as well as their opinion on the possible solutions to improve the mining sector within the Valea Jiului area in general. The measures taken in order to render the institutional system more efficient and more flexible have affected both the employees who were laid-off, as well as those who remained within the system. The employees’ assessment of the financial situation and the current work conditions shows to a certain extent the degree of contentment or lack of contentment of the subjects with the current work conditions. In order to analyze the effects produced by the changes occurred due to the restructuring of the mining sector, we have to see how these transformations influenced the life of the employees in particular and that of the company in general. First of all, the changes brought about by the national reformations have strongly influenced the financial situation of the population in general. Moreover, the financial situation can be evaluated from the point of view of various salary losses. Almost three quarters of the people interviewed believe that their financial situation has been greatly affected. The stagnation of salaries has been attributed to a lack of state subsidies, as well as to factors related to the productivity of work. During 1990 -1994, any salary claim would be satisfied, and if not, it would be peacefully supported through certain forms of manifestation, until reaching a consensus satisfactory for those claiming their rights. Following 1997, such protest forms were attempted again, but the financial and material incentives diminished. With the onset of the economic crisis, which affected the entire world, the incomes became insufficient to support one’s family and to ensure minimal decent living conditions. All these aspects have affected the situation of each employee. At the same time, we notice that the majority share of respondents incline towards a deterioration of the mining sector following 1997. That years is taken as a reference year, because it represents the beginning of the process of enforcing the politics on the restructuring of the mining field, by applying OUG 22/1997 on personnel layoffs, when the percentage of layoffs in 1997 reached 48%, according to the analysis of the data on personnel layoffs recorded during 1990 – 2011, within the National Coal Company. Therefore, the poignant limitation of the coal production during the second half of the 90’s is not so much the result of the implementation of a coherent restructuring and efficiency strategy, which should have been applied immediately following 1989. It was necessary to adapt the system to a market economy, from both a structural and a functional point of view, because a system based on a free market economy is built on competitiveness, efficiency, competition and hierarchy of values, while a system with a planned centralized economy promotes noncompliance with the hierarchy of values and a more reduced efficiency. When referring to the dynamics of transforming a centralized system into a free economy one, professor Krausz Septimiu points out two directions for the incongruities related to the first reparatory measures applied during the 1990’s, which
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should have engaged a more correct understanding of the need for a change. (134) These measures could have been justified by the frustrations generated by the system with a planned economy, which believed in the collective mentality that a person with modest qualifications could be supported by society through the fact that they benefitted from the privilege of becoming unemployed. The other direction refers to the exaggeration of the claims promoted, during the first post-December years, regarding working hours, salary or retirement age. These subjective aspects have slowed down the creation and implementation of certain adaptation mechanisms of the institutional structures to a working and efficient system. We find that the predominance of answers given to another question targeting the current problems within the Valea Jiului area is overwhelming in what concerns the absence of alternatives for the absorption of work force (91.21%). Two thirds of the subjects believe that another problem, mainly due to the restructuring of the mining sector within the area, and to the layoff of a significant part of the work force, is the occurrence and establishment of unemployment. The institutional reorganization of the industrial sector was one of the main premises for the reformation process, consisting of a series of measures and actions meant to create a mechanism that would ensure the national economy a sustainable functional structure that would function at a high performance level. In this context, the managerial experiences within the last years, regarding the organizational measures adopted within the institutional strategic framework including the company, have targeted mainly the invigoration of the activity in terms of economic performance that would lead to more efficient organizational structures and to an increase of work productivity. In this regard, the sociologic analysis, from the point of view of managerial experiences, is placed within the practice of industrial unit management. It was observed that almost a third of the subjects believe that institutional reorganization is “rather not” a solution for the future of viable mines in the process of institutional efficiency. It is observed that the decrease in the usage of coal as an energy source is justified by the closing down of certain economic units that used part of the coal exploited to produce steel. The decreased usage of coal within the last few years is also explained by the decrease in the usage of energetic pit coal for electrical energy extracted within the area, due to the relatively high cost as compared to that of imported coal. The economic crisis represents a serious factor that should be taken into consideration, because it significantly contributes to the process of limiting certain activities both in the field of mining, as well as in other fields of activity, slowing down the functioning of the system or even interrupting the activity during a larger or smaller period of time. We observe that almost half of the subjects believe that the lack of investments is the greatest problem of the stagnation of mining, another great dysfunction in terms of mining being the absence of national field policies, followed by the much too obsolete technology and a faulty management, in the subjects’ opinion. Almost half of the subjects believe that the lack of money for subsidies is the main cause that led to the restructuring of the mining sector, generating organizational and structural changes, personnel layoffs and the shutting down of numerous mining units. In the subjects’ opinion, almost a third of them identified as another problem that has led to the mutations listed above the lack of outlets, and then a smaller percentage believe that the focusing on alternative and renewable resources would be another cause for the restructuring of the mining sector.
Conclusions and recommendations The need to maintain a social and economic life within the Valea Jiului area, as well as a positive evolution of the area, mainly entails solutions meant to reduce the institutional death rate, as a means of awareness of the negative tendency of the Valea Jiului area. When the mining personnel layoff measures were implemented, the situation of the Valea Jiului area was aggravated. This measure, part of the institutional reforming process, has failed to prove its efficiency, because 20 years following the transition, the great problem of the Valea Jiului area, also supported by the majority of the subjects, is the lack of work places. This aspect shows the lack of a perspective based on sustainable development for other activity areas that would ensure a viable sustainable development alternative for the area. In what concerns the economic re-launch of the social space researched, the subjects listed the following alternatives: The undergoing managerial restructuring should focus on creating new work places and on optimizing the conditions of professional expression for all professional segments in the mining sector. Therefore, the overcoming of the narrow economic vision on mining entails a re-evaluation of the entire situation, starting from the social parameter, respectively from the creation of new job opportunities for those who were laid-off, but also for the young generations to come, that may opt to continue the traditions within the Valea Jiului area. The initiation of a strategic program meant to create alternative occupations for the population in the area. The envisioning of professional alternatives as a realistic perspective to capitalize on the professional potential of the area is another of the possible solutions meant to increase the employment rate and the economic optimization of the area. This prerogative represents the perception of the social actors subjected to the authority of the regional and local decisions made. After analyzing the current 2013 situation of the area, a regeneration
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plan for the Valea Jiului area should be drafted, supported by certain and real propositions, which can be monitored and quantified into results.
References [1] [2] [3] [4] [5] [6] [7] [8] [9]
Anghel Mariana Eleonora, (2013), Natalitate şi mortalitate instituţională – O perspectivă sociologică asupra mineritului, Doctoral thesis, The West University of Timişoara, Coord. Prof.univ.dr. Buzărnescu Ştefan. Buzărnescu, Ştefan, (2008), Sociologia conducerii, Editura de Vest, Timişoara; Chelcea, S. (2001), Metodologia cercetării sociologice. Metode cantitative şi calitative, Editura Economică, Bucureşti. Corici Miron, (2012) Optimalizarea activităţii manageriale ca factor de influenţă al performanţei organizaţionale, Editura Unversităţii de Vest, Timişoara, pp. 99-102. Drucker, Peter, (1994), Management. Eficienţa factorului decizional, Editura Destin, Deva. Fulger Ioan Valentin (2007), Valea Jiului după 1989, spaţiu generator de convulsii sociale, Editura Focus, Petroşani. Krausz Septimiu, Inerţia mentalităţii ca frână a tranziţiei: exemplul atitudinii faţă de restrângerea activităţii, în Krausz Septimiu (coord.) Sociologia tranziţiei, Editura Universitas, Petroşani, 1999, p. 134. Pop, Luana Miruna (2003), Imagini instituţionale ale tranziţiei: pentru o sociologie a retroinstituţionalizării, Editura Polirom, Iaşi, pp. 136-139. Vlăsceanu Mihaela (2003), Organizaţii şi comportament organizaţional, Editura Polirom, Iaşi, p93.
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From independence to strength: Institutional resilience and coping mechanisms in NGOs providing social services financed through public financing mechanisms Baciu L. West University of Timișoara (ROMANIA)
[email protected]
Abstract The Public-Private Partnership (PPP), under its various forms (from privatization of public services to subsidies for private bodies) has been discussed in many occasions and found to be one of the most desirable methods for developing social services tailored on the needs of the communities. What happens with the NGO once entered in such partnership and how its structure and form changes because of it, is an entirely different matter, which has not been discussed as much. The current paper is focused on analysing the changes brought to the NGO (in terms of structure and function) by the experience of accessing and managing public financing and the struggle of these entities to remain independent, while passing through this experience. Local research at the level of Western region, Romania, showed the coping mechanisms used by the NGOs in their fighting for survival during the period of post-communist private donors’ withdrawal. The implications of adopting the public funding solution are also analysed and discussed. Keywords: public financing for NGOs; organizational autonomy, identity and development; institutional coping mechanisms.
The third sector organizations – alternatives or complements of the Governmental institutions? After 1980, the third sector (represented by the non-governmental non-profit organizations) started to gain more and more public recognition at the level of the EU. Some of the delays, inconsistencies, and inertia periods [1] were counterbalanced by the various research initiatives focused on understanding the role and place of the third sector in a modern democratic state [2], thus making possible the current progress known by the third sector, which is now almost unanimously recognized in EU as an equal and reliable partner of the governmental institutions [3], the establishment of the European Economic and Social Committee (EESC) being just one of the numerous examples of the third sector`s current status in the EU. Various authors [4, 5] consider that the recent and accelerated growth of the third sector organizations in Europe can be considered a sort of an institutionalized response to the market and state failure, generated by the dependency and universality embedded in the provision of the social services. As compared to the public sector, the private sector (including non-profit organizations) has been analysed and found to be more flexible [6], more efficient [7] and productive [8], easier to manage and administer [6], and, at the same time, with relatively more motivated and satisfied employees [9]. Of course, many of these findings were highly debated [10]. The popularization of these results made possible for the third sector organizations to improve their public image and gain even more public support.
1.1
Public financing – opportunity but also a risk
The public financing mechanisms available for the NGOs are numerous and diverse as regarding their purpose, nature and administering procedures, varying from direct financing in the form of grants, subsidies or loans [11], to more indirect and subtle forms of assistance, as tax exemptions on income or tax incentives on philanthropy [12].
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In a visionary article, published almost two decades ago, Bossuyt and Develtere [13], after reviewing and cataloguing the most important four approaches used in public financing mechanisms for the Northern NGOs (the famous „program”, „project”, „windows” and „Quango” approaches), make a very interesting point in highlighting the fact that, in their efforts to self-ensure a certain level of financial stability by accessing public funds, the NGOs risk losing in some extent either their autonomy (becoming dependent on the public financing bodies and adapting the structure and internal mechanisms to the requirements of those external factors) or their identity (becoming more market-oriented and losing touch with their initial mission and objectives). Of course, both those risks could be prevented by not accessing and/or using public funding, but, in a time of shortage of private resources, this is a luxury that only a few NGOs can afford.
Study regarding the Influence of public financing on the structure and functioning of recipient NGOs 1.1
Methodology of the study
In 2010, a research was conducted on a sample of 28 NGOs accredited as social services providers in the Western Region of Romania (in Arad, Caraș-Severin, Hunedoara and Timiș counties). One of the objectives of the research was to establish if the public funding has an impact on the recipient NGO and, if so, what is this impact, in terms of autonomy, identity and development level. This part of the study used the perspective of Bossuyt and Develtere [13] enounced earlier and was based on the assumptions that, in time, the public funding impacts the activity and identity of the recipient NGOs, (1) making them less autonomous, but (2) more developed and, at, the same time, (3) more marketoriented, derailing them from their initial mission. Moreover, the horizontal assumption of this part of the study was that, these effects are directly proportional with the experience of the NGOs in accessing and managing public funds.
1.1.1 The method The organizations were selected from the on-line database of the Ministry of Work, Family and Social protection and were all, at the time of the study, private accredited social services providers from the Western Region, Romania. In order to collect the necessary information from the organizations, a questionnaire with 32 items was sent to the organizations` representatives. The items referred to different technical, operational, financial and statutory aspects of the organization`s activity within the last 3 calendar years (2007-2009). The answers collected were included in a database and their statistical interpretation was conducted with the SPSS program – version 12.00 for Windows.
1.1.2 Operationalization of concepts Organization`s level of development (low, average and high) - its financial and operational capacity, expressed in five characteristics: total number of employees in the last 3 years; the percentage of qualified employees from the total number of employees, within the last 3 years; annual budget over the last 3 years; total number of projects implemented by the organization within the last 3 years; annual average number of beneficiaries over the last 3 years. Autonomy of the NGO (low, average and high level) – its capacity to maintain the control of certain structural and functional organizational aspects, expressed through not altering the structure and functioning of the organization (mainly motivated by compliance with eligibility rules for accessing certain public financing programs) in regard to the following components: statute (mission and objectives), personnel structure, activities, target group, partnership network, reporting methodology, working methodologies within the financial/accounting department. Experience regarding public funding (low, average and high level) – expressed by the percent of the public-financed projects in the total number of annual project implemented; number and type of applications submitted for public funding over the last 3 years; number and type of public funding obtained over the last 3 years. Level of public financing (low, average and high level) – expressed through the percentage of public funding in the total annual budget. Orientation towards a certain type of partnership structures (towards public partners, towards private partners and un-defined) – calculated based on the number of partnerships/collaborations the NGOs had established and the nature (public or private) of the partners.
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1.1.3 The results The results of the study confirm the initial assumptions in all three regards: Indeed, there are strong evidences that the public financing impacts the recipient NGO in terms of autonomy, development level and identity, as shown below. a) The influence of public funding over the autonomy level of the recipient NGO The crosstabulation between the level of experience in managing public funding and level of autonomy of the organization show (Table 1) show that, the two characteristics find themselves in an inverse proportionality relationship: as the level of experience in managing public funds raises, the level of autonomy of the NGO decreases. Most of the NGOs that report a high level of autonomy (80%) are organizations with a low level of experience in managing public funding. Half (50%) of the organizations with a low level of autonomy are identified as organizations with high level of experience in managing public funding. Interestingly enough, an average level of autonomy relates more with a low level of public funding experience (67%) than with an average level of experience (33%). This situation, in our opinion, describes the NGOs that have been making all necessary efforts to access public funding, but still didn`t succeed. Table 1. The experience level in managing public funding * The level of autonomy Crosstabulation Level of autonomy of the organization Low Average High Level of experience managing public funding
in
Low Average High
Total
Total
3
4
8
15
3 6 12
2 0 6
1 1 10
6 7 28
These results are further confirmed, when the level of autonomy is put in connection with the level of public funding as a percentage in the total budget of the organization (Table 2). Thus, we can observe that the organizations which present a high level of public funding as percentage from their annual budget are those described by a low (80%) or average (20%) level of autonomy. None of them has registered a high level of autonomy. Moreover, all the organizations that present a high level of autonomy are described exclusively by a low level of public funding. Table 2. Level of autonomy * Level of public funding in the annual budget of the organization Crosstabulation Level of public funding – Percentage from the annual budget Low Average High Level autonomy
of
Low Average High
Total
Total
7
1
4
12
5 10 22
0 0 1
1 0 5
6 10 28
b) The influence of public funding over the development level of the recipient NGO The organization`s general development level over the period 2007-2009 was put in relationship with two variables: the level of experience in managing public funding and the level of public funding as a percentage in the total budget of the organization (Table 3 and Table 4). Both crosstabulations show us a consistent, although incomplete picture: Table 3. The general development level * Level of experience in managing public funding Crosstabulation Level of experience in managing public funding Low Average High General development level
Low Average High
Total
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2
4
16
4 1 15
3 1 6
1 2 7
8 4 28
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Table 4. The general development level * Level of public funding in the annual budget of the organization Crosstabulation Level of public funding in the annual budget of the organization Low General development level
Low Average High
Total
Average
Total
High
12
1
3
16
7
0
1
8
3
0
1
4
22
1
5
28
Thus, while both crosstabulations clearly indicate a consistent connection between the low level of general development and a low level of both experience in managing public funding and public funding as percentage in the annual budget, still, none of them is valid for the opposite: the high level development seems to have no connection with neither the level of experience in managing public funding nor the level of public funding as percentage in the annual budget. This could be translated into the following conclusion: while the public funding does not necessarily guarantee the development and/or progress of the organization, still, it could be an efficient solution for overcoming the risk of decline or stagnation for an NGO. Moreover, we can observe that the level of public funding in the annual budget of the organization is equally un-involved in inverse proportionality relations – the high-low connection is equally distributed (11%) between the organizations high level of general development and a low level of public funding in the annual budget and between the organizations that have a low level of general development in spite of their high level of public funding in the annual budget of the organization. Once again, this draws attention on the inconsistent relation between public funding and organizational progress of NGOs. This means that the NGOs that manage to register progress over a certain period of time have a very well extended repertoire of solutions for facing the challenges in their development. We could surely say about these organizations that they have managed to be resilient to external negative impact factors (for example, the decrease in number of the private donors in the last years), but without using the very popular coping mechanism used by the large majority of NGOs to overcome financial difficulties - that of accessing public funding. c) The influence of public funding over the identity of the recipient NGO When crosstabulating the orientation of the NGO towards a certain kind of partner networks and its level of public funding as percentage in the annual budget (Table 5), we notice that the majority of the organizations that register a low level of public financing (59%) are more oriented towards collaborations with private partners, while most of the organizations with high levels of public funding (60%) are more oriented towards public partners and collaborations. Table 5. The orientation towards.... partnerships * Level of public funding as percentage of the annual budget Crosstabulation Level of public funding in the annual budget of the organization Low The orientation towards.... partnerships
Average
Total
High
Private
13
0
1
14
Public
7
1
3
11
Un-defined
2
0
1
3
22
1
5
28
Total
If we add also to the picture the situation of the changes made by NGO representatives in the structure and functioning of their organizations, as a result of or in order to meet the eligibility requirements for public funding (Figure 1), that we have previously used for evaluating the organization`s autonomy level, but is also a good indicator for the organization`s capacity of keeping its identity over time, we can observe that, indeed, the access to public funding impacts the NGOs identity in notable ways. It would be very interesting to also have a feed-back on the public perception regarding this process of adjustment used by the NGOs to cope with the changes in their environment.
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Fig. 1 Organizations that operated changes regarding the following dimensions, as a result of or in order to meet the eligibility requirements for public funding Statute Personnel structure Activities Target group Network of collaborators Reporting methodology Financial/ Accounting methodology 0
10
20
30
40
50
60
70
Percentage in total sample
1.2
Conclusions of the study
While it is clear enough that the public financing has its positive and negative effects over the recipient NGO, we cannot say for sure if the risks it encumbers are worth taking on. After all, as we observed, the level of development in terms of progress seems in no way influenced by the use of public funds. On the contrary, if we were to analyse just the organizations that have registered overall progress over the last 3 years previous to the study, we would observe that most of them (60%) preferred other donors instead of public ones. At the same time, we clearly see that the large majority of the organizations that were in trouble during this period (low development level) are organizations with low interest/experience in public funding. In terms of impact on organizational development, this would make the public financing for the NGOs more a vaccine than a medicine – it will help prevent the disease, but it will not cure the patient. As about the two other matters in discussion (autonomy and identity of the recipient NGO), we observed that they are both affected in case of long or intense exposure to the public funding of the recipient NGO. This involves two inter-related risks: - firstly, the NGOs become in time more institution-like and, thus, more bureaucratic, losing the only feature the researchers agree it`s superior within NGOs than in public institutions – their flexibility; - secondly, because of this „derailment” from their initial mission statement, the NGOs could lose the support of the community members, because, probably, these members have given their initial support to the NGO in first place because it represented an viable alternative to the public institutions that have failed to answer satisfy their trust. Acting in these conditions and choosing a solution over another is really nothing else but a mediumversus-long-term thinking. We could say that it is probable for the long term perspective to be the winner in this case (the NGOs who choose to stand by their initial mission statement and avoid the traps of public funding), but at the same time we are very aware that this victory has very slim chances to take place in this advertising-ruled society, where the, currently, those most visible seem to be the most appreciated.
References [1] [2]
[3]
Kendall, J., Anheier, H. K. (1999) “The third sector and the European Union policy process: an initial evaluation”, Journal of European Public Policy, 6 (2), pp. 283-307 Donnelly-Cox, G., Donoghue, F., Hayes, T. (2001) “Conceptualizing the Third Sector in Ireland, North and South”, Voluntas: International Journal of Voluntary and Nonprofit Organizations, 12 (3), pp. 195204 Chaney, P. (2002), “Social capital and the Participation of marginalized Groups in Government: A Study of the Statutory Partnership Between the Third Sector and Devolved Government in Wales”, Public Policy and Administration journal, 17 (4), pp. 20-38
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[4]
[5] [6] [7] [8] [9] [10] [11]
[12] [13] [14] [15]
Laville, J.-L., Nyssens, M. (2000) Solidarity-Based Third Sector Organizations in the "Proximity Services" Field: A European Francophone Perspective, Voluntas: International Journal of Voluntary and Nonprofit Organizations, 11 (1), pp. 67-84 Anheier, H. K. (2002) Third Sector in Europe: Five Theses, Civil Society Working Paper 12, pp. 1-10 Warwick, D.P. (1975), A theory of public bureaucracy, Cambridge, Mass.: Harvard University Press Rainey, H.G., Bozeman, B. (2000), Comparing Public and Private Organizations: Empirical Research and the Power of the A Priori, Journal of Public Administration Research and Theory, 10 (2), pp. 447-469 Pugh, D.S., Hickson, D.J., Hinings, C.R. (1969), An empirical taxonomy of work organizations, Administrative Science Quarterly, Vol. 14, pp. 115-126 Solomon, E.E. (1986), Private and public sector managers: An empirical investigation of job characteristics and organizational climate, Journal of Applied psychology, Vol. 71, pp. 247-259 Bozeman, B., Loveless, S. (1987), Sector context and performance: A comparison of industrial and government research units, Administration and society, Vol. 19, Issue 2, pp. 197-235 Knapp, M., Robertson, E., Thomason, C. (1990) “Public Money, Voluntary Action: Whose Welfare?” in H.K. Anheier & W. Siebel – ed. The Third Sector- Comparative Studies of Nonprofit Organizations, Berlin: Walter de Gruyter Bullain, N., Toftisova, R (2005) A Comparative Analysis of European Policies and Practices of NGO‐Government Cooperation, The International Journal of Not‐for‐Profit Law, 7 ( 4) Bossuyt, J, Develtere, P. (1995) “Between autonomy and identity: The financing dilemma of NGOs”, în The Courier ACP-EU, Nr. 152, pp. 76 – 78 Salamon, L.M. et al (1999) Global Civil Society. Dimensions of the Nonprofit Sector, The Johns Hopkins Center for Civil Society Studies: Baltimore Petrescu, C. (2004) Public subsidies for social services. Case study on the Law no. 34/1998, The Social Work Review, No. 1, pp. 47-58
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Resilience in humanitarian aid workers: Understanding processes of development Comoretto A. London South Bank University (UK)
[email protected]
Abstract The objective of this study was to assess a conceptually based model of resilience development, centered on the interrelationship of three groups of protective factors (individual, cognitive, environmental), in a cohort of humanitarian workers deployed in the field. This was a mixed-method investigation incorporating a longitudinal survey design and qualitative interviews. A structured questionnaire composed of 11 different scales designed to measure key protective/adverse factors were administered to humanitarian aid workers (N= 56) preand post-deployment in the field. These questionnaires incorporated previously validated and widely used scales to measure resilience levels, work stress, coping skills, social support networks, general health, self-efficacy, and dispositional optimism/pessimism. Semi-structured interviews were subsequently conducted in a sub-group of participants (N= 15) to qualitatively explore the interrelationship of groups of protective factors. The presence of Post-Traumatic Stress Disorder, the use of mental disengagement as a coping technique, the age at which participants had left education, and the presence of social support networks significantly predicted changes in resilience over time. Dispositional and environmental protective factors interrelated and positively influenced the way humanitarian workers perceived and coped with mission stressors. The coping strategy of mental disengagement, affected by the stress domain, was found to negatively influence changes in resilience via a direct pathway. To conclude, the model tested in this investigation partially accounted for the explanation of mechanisms of resilience development suggesting a direct relationship between work environment and individuals’ emotional and psychological well-being. Keywords: resilience; humanitarian aid workers; longitudinal study; mixed methods; stress; coping
Introduction Resilience describes the factors that promote wellbeing and strength in individuals who are undergoing unusually stressful life conditions. It concerns acutely traumatic experiences followed by positive psychological outcomes despite those experiences. 1 Over the past three decades the study of resilience has received increased attention. 2 The construct is relatively new, however, and issues such as generally accepted definitions are still in the process of development. The international humanitarian aid workers literature is characterised by increasing attention towards workplace adversity. Thus a great deal of research attests to the organisational challenges currently facing humanitarian workers in many parts of the world. Even a brief review suggests that aid workers have to cope with a whole range of work-related challenges, such as occupational health and safety issues 3, concerns around re-entry stress 4, pre-existing problems such as earlier psychiatric treatment 5, in addition to the obvious stress of working in disaster and war situations, with continuous exposure to human suffering.
Protective factors in resilience research Three overarching protective categories, applicable to populations at risk for stress (among which humanitarian aid workers) can be identified 6 : a) attributes of the individual (e.g. age, gender, physical health, etc.); b) cognitive features (e.g. motivation, locus of control, optimism, self-efficacy); and c) characteristics of the wider social environment (work colleagues, family, peers). Because many aid workers often survive and thrive within very demanding organisational situations, the issue of why some people are able to thrive and continue to find satisfaction with their careers, while others are not, naturally arises. To answer this question, a mixed-method study was carried out with the aim of assessing which humanitarian workers would be more resilient than others, and therefore better equipped at coping with workplace adversity. It was hypothesised that the three key areas of protective factors (individual, cognitive, and
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environmental) would interrelate and buffer the effects of stress, while at the same time favouring negative or positive changes in resilience.
An original theoretical model in in resilience research An original theoretical model was developed to test several hypotheses about the origins of resilience in adult populations carrying out highly demanding jobs. It was theorised that positive or negative changes in resilience would be governed by dynamic relations among protective factors within the individual and the wider environment. More specifically, cognitive and environmental factors were thought to impact on individuals’ psychological responses during stressful life experiences, at the same time mediating fixed dispositional markers. Thus, it was hypothesised that the interrelationship of these three domains could affect changes in resilience, which could be of two types: positive (increase in resilience) or negative (decrease in resilience). In addition, the relationship between dispositional resources and outcome was thought to mediate environmental constraints and perceived levels of threat (the stress domain). Fig. 1 is a graphic representation of this theoretical construct.
MEDIATORS COGNITIVE PROTECTIVE FACTORS •
Motivation Self-efficacy Internal Locus Control
INPUT DISPOSITIONAL PROTECTIVE FACTORS •Gender
Optimistic self-beliefs
•
Coping skills
•Age •Number of previous missions •Physical health •Marital status •Age at leaving education •Intelligence
MEDIATORS ENVIRONMENTAL PROTECTIVE FACTORS •Social support from family and friends at home •Social support from colleagues •Organisational support
Figure 1
S T R E S S R E L A T E D
OUTCOME: CHANGES IN RESILIENCE POSITIVE Increase in resilience NEGATIVE Decrease in resilience
I N D I C E S
A model of dispositional, cognitive and environmental factors developed from the literature and tested to examine changes in resilience
Study design To test the aforementioned model a mixed methods investigation was implemented in two phases: a longitudinal self-completion questionnaire survey (phase I) and a series of semi-structured qualitative interviews (phase II). In phase I self-report questionnaires were completed by expatriate staff members of a number of humanitarian agencies at two points in time. Baseline questionnaire administration (time 1) took place before participants were sent to the field; follow-up administration (time 2) began when humanitarian aid workers were back from the field. The survey provided extensive data, contextualised the interview phase (phase 2), and supplied a sampling frame for the interviews. The questionnaire incorporated different already validated and well-known scales: the Los Angeles Symptom Checklist (LASC) 7, the Maslach Burnout Inventory (MBI) 8, the COPE 9, the Generalised Self-Efficacy Scale (GSE) 10, a modified version of the Rotter’s Internal-External Locus of Control Scale 11, the Life Orientation Test (LOT) 12, a modified version of the Social Provisions Scale (SPS) 13, and the Self-Report Questionnaire-20 items (SRQ-20) 14. In addition, three resilience scales, the Ego Resiliency Scale (ER-89) 15, the Connor-Davidson Resilience Scale (CD-RISC) 16, and the Resilience Scale for Adults (RSA) 17 were included. In phase II the chosen methodology involved the use of qualitative interviews to investigate, participants’ accounts of field experiences. A semi-structured question schedule was followed to allow themes surrounding resilience and the experience of humanitarian work to emerge. Moreover, it permitted the analysis of those existing social networks that positively affected the relation between exposure and reactions to trauma in participants.
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Statistical analyses To test the aforementioned model a mixed methods investigation was implemented in two phases: a Pearson correlations explored bivariate relationships among the questionnaire’s scales and subscales at baseline and at follow-up. Moreover, independent samples t-tests were used to assess whether the individual protective factors in the model (i.e. age, gender, age at leaving education) could be associated to changes in resilience from baseline to follow-up. Multiple regression analysis examined whether changes in resilience from baseline to follow-up would be explained by the three sets of protective factors considered in the model. Path analysis provided quantitative estimates of the likely causal connections (path coefficients) between sets of predictor variables highlighted in the model. The qualitative data collection phase involved the conduction, coding and analysis of 15 interviews.
Results A total of 56 people took part in the study: 23 were males (41.1%) and 33 females (58.9%). Females (r= -6.298, p< 0.001) and unmarried participants (r= 3.982, p< 0.05) were found to be more likely to experience positive changes in resilience from baseline to follow-up. Similarly, humanitarian workers with high selfefficacy levels (r= -0.429, p< 0.01), and people presenting with lower levels of depersonalisation before deployment (r= -0.940, p< 0.05), reported significant increases in resilience levels at follow-up. Social support (r= 0.454, p< 0.01), use of humor (r= 0.739, p< 0.01), and behavioural disengagement (r= -1.070, p< 0.01) as coping strategies, together with high levels of personal accomplishment (less burnout experienced) (r= -0.268, p< 0.05), positively influenced changes in resilience measured before deployment. Next, path analysis technique was used. Table 1 shows the four variables which, as a result of the initial regression, had beta coefficients that significantly predicted changes in resilience. Table 1 ß coefficients for the four variables that significantly predicted changes in Independent variable
LASC total score Age at leaving education SPS total score COPE mental disengagement subscale
B
ß value
0.091*** -2.110** 0.742*
0.605 -0.690 0.401
-1.679*
-0.330
resilience
Figure 2 shows a diagrammatic representation of the structural model achieved by the analysis.
CO GNITIVE PRO TECTIVE FACTO RS COPE mental d isengag ement su bscal e
P4
P7
P10
P5
P3
DISPOSITIO NAL PRO TECTIVE FACT ORS Ag e at l eavin g educati on
OUTCOME CHANGES IN RESILIENCE
P8
STRESS LASC scale
P6
P2
P9 ENVIRONMENTAL PROTECTIVE
P1
FACTO RS SPS scale
Figure 2 Model used to explain changes in resilience and its associated paths
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Because this tested theoretical model could not be saturated due to the small number of participants in the study, the four variables included in the path analysis were chosen on the basis of theoretical reasons. First, age at leaving education represented the group of dispositional protective markers and was chosen over, for instance, age, gender and number of missions because it represented intelligence, one of the most critical features affecting the ability to cope with adversity. Second, the SPS scale highlighted the presence of environmental protective factors, which are thought to shield against stress. Third, the LASC was chosen to characterise perceived stress and was selected in preference to the Maslach Burnout Inventory (MBI) because it came out more frequently as an indicator of stress. Finally, the COPE mental disengagement subscale was selected to represent the area of cognitive protective factors because it significantly affected changes in resilience as measured by the CD-RISC, the resilience scale influenced by the highest number of variables representing the three protective factors groups. Table 2 displays the direct, indirect and spurious effects of each predictor of the dependent measure changes in resilience. Table 2
Direct, indirect and spurious path coefficients for each predictor variable, for each resilience scale
CD-RISC scale Age at leaving education SPS scale LASC scale COPE mental disengagem. ER-89 scale Age at leaving education SPS scale LASC scale COPE mental disengagem. RSA scale Age at leaving education SPS scale LASC scale COPE mental disengagem.
Direct -0.117 (P3) 0.243 (P1) 0.362 (P2) -0.229 (P4)
Direct -0.033 (P3) 0.202 (P1) 0.294 (P2) -0.064 (P4)
Indirect
Spurious
Total effect
Zero order correlation coefficient (Pearson’s r)
-0.132
0
r = -0.249
-0.257
-0.125
0.045
r = 0.163
0.164
-0.004
-0.035
r = 0.323
0.336
0
0.033
r = -0.196
-0.124
Indirect
Spurious
Total effect
Zero order correlation coefficient (Pearson’s r)
-0.122
0
r = -0.155
-0.217
-0.105 -0.001
0.027 -0.048
r = 0.124 r = 0.245
0.132 0.264
0
0.020
r = -0.044
-0.042
Direct
Indirect
Spurious
Total effect
Zero order correlation coefficient (Pearson’s r)
-0.18 (P3)
-0.104
0
r = -0.284
-0.324
0.265 (P1) 0.1 (P2)
-0.041 0.004
0.047 -0.001
r = 0.272 r = 0.102
0.287 0.125
0.195 (P4)
0
0.025
r = 0.220
0.133
Together table 2 and figure 2 show that the association between the LASC, assessing the severity of PTSD, and changes in resilience was determined mainly by a direct path, with little influence from intervening variables. People suffering from PTSD were therefore more likely to report negative changes in resilience than colleagues not affected by this mental health problem. The finding that participants employing mental disengagement coping techniques were characterised by negative changes in resilience was also best depicted by a direct causal link. Moreover, the relationship that people suffering from PTSD and employing mental disengagement coping strategies were less protected against negative changes in resilience was also dependent upon indirect links via age at which people had left education and the presence of social support, even though the social factor was the variable with the lowest impact on the outcome. Mirroring the quantitative findings, the 15 qualitative interviews found that participants were characterised by several cognitive protective factors that helped them thrive despite difficulties. For instance, job satisfaction was one of the crucial elements in protecting individuals against stress. Similarly, internal locus of
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control (LOC), namely the belief that outcomes and behaviours were largely within one’s control, was related to positive changes in resilience. Moreover, high self-efficacy and optimism prevented people from developing work-related stress. The varying strengths and weaknesses of the social network relations available to aid workers were also highlighted during interviews. Participants talked about types of social support, but also about positive and negative social processes, as well as long-term consequences of humanitarian work on already existing social ties.
Discussion This study hypothesised resilience as being influenced by dispositional, cognitive and environmental protective factors, which could substantially account for the development of post-mission resilience. Female participants were more likely to experience positive modifications in resilience from baseline to follow-up. There have been a number of suggestions stressing the fact that gender may influence or modify responses to adversity. Social relationships may be the key to women’s thriving. Women facing hardship, in fact, report that they have more support available than men, and that they are more likely to seek help in times of need. 18 Age at which participants had left education mediated the effects of stress on changes in resilience. Taylor and Frazer 19 observed a significant negative correlation between age and stress development in rescue workers handling dead bodies. Not only did those in the lower stress group tended to be older; they also demonstrated a quicker return to their normal pattern of eating, sleeping and feeling at task completion. An age effect explaining this reported behaviour was not excluded by the authors of the study. The strengths of the social networks available to aid workers were explored both quantitatively and qualitatively. Path analysis results indicated that social support mediated the effects of both stress and maladaptive coping on changes in resilience. At the end of their study on the mental health of humanitarian aid workers in complex emergencies, Cardozo and Salama 20 concluded that family networks were essential in the lives of humanitarian personnel because these allowed staff to offset the stressors encountered during field deployment. Interviewed participants reported feeling psychologically vulnerable because of the stressful job demands endured during their mission. Yet the majority of them described themselves as resilient individuals, determined to go back to the field in spite of the difficulties experienced. This might indicate that participants were able to adapt and grow to the difficult tasks intrinsic to the mission despite the stressful environments in which they were operative. Four markers significantly predicted changes in resilience from baseline to follow-up, namely participants’ scores on the LASC, indicating levels of PTSD, the use of a specific coping strategy (mental disengagement), the age at which participants had left education, and the presence of social support networks. First of all, perceived stress, in the form of PTSD, was weakly and positively associated with the use of mental disengagement, which in turn was negatively associated with a positive outcome (positive changes in resilience). Coping strategies such as mental disengagement are aimed at avoiding active confrontation of the stressor, and in the literature they have been linked with more stress and less resilience. 21 Second, the mental disengagement coping technique was found to be directly related to changes in resilience in a negative way, which was congruent with the fact that this strategy is considered non-adaptive over the long-term. 9 Although disengaging from a goal is sometimes a highly adaptive response, this approach often impedes active coping. 22 Third, age at leaving education, used as an indicator of intelligence (i.e. the older people were when they left school, the more intelligent they were considered to be), was the second most significant predictor of post-deployment changes in resilience. Social support and mental disengagement partially mediated the effect of intelligence on resilience. At the same time, stress mediated the effect of both intelligence and social support on resilience. Age at leaving education was negatively associated with the use of mental disengagement and with the presence of PTSD symptoms, implying that people who had left school at a later stage were more likely to rely on functional techniques to deal with stress and to be more protected against the development of psychopathology. The positive relationship between intelligence and resilience has mainly been documented in children and adolescence literature, where this feature has been described as a key protective factor against adversity. 23 Finally, social support was the fourth statistically significant predictor of over-time changes in the outcome, mediating the effects of both stress and maladaptive coping. To conclude, contrary to what was predicted by the theoretical model, only two of the three domains of protective factors (the dispositional and the environmental one) seemed to interrelate and positively influence the way humanitarian workers perceived and coped with the stressors characterising field missions. The cognitive area, affected by the stress domain, was found to negatively influence changes in resilience via a direct pathway only.
Conclusion This study on resilience processes in an adult population (humanitarian aid workers) was the first to combine a longitudinal survey with semi-structured qualitative interviews, a design which improved the
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reliability of the study findings. Participants differed greatly from each other in terms of experience, age, and nationality, thus the generalisability of the project was enhanced. A theoretical model was developed by taking into account three types of protective markers and by assessing how these interrelated with each other. Fixed dispositional protective factors were theorised to mediate environmental and cognitive variables, with the possibility of obtaining positive or negative changes in resilience. This relationship among dispositional, environmental and cognitive factors was considered to mediate perceived levels of stress. Luthar and colleagues 24 observed how exposure to stress may sometimes end up with positive individual growth and development rather than psychopathology. Tugade and Fredrickson 25 suggested that everyone has resilience potential, but its level is determined by interpersonal and cognitive characteristics, by the environment, and by each person’s balance of risk and protective factors. Aid workers are a very diverse group, ranging from school leavers to retired people, who may work alone, with a partner or as part of a team, in a conflict region or a peaceful area, for weeks or for decades. Some are involved with relief work, while others participate in development projects only. Some find the experience traumatic, while others enjoy it. There are a large number of variables which have not been considered in detail in this study, mainly because of the limited number of participants recruited, and which may warrant further investigation. For instance, further research could explore related topics, such as: a) the specific characteristics of resilience among non-Western international workers and national staff (employees working in their own countries), as well as the most appropriate way to maximise the development of resilience processes; b) the diversity of interrelationships present within humanitarian aid workers teams, as well as their positive and adverse impact on collective resilience; c) the real impact of more resilient aid workers on the population they come to serve, as well as on colleagues and organisations. To conclude, humanitarian workers’ occupational setting is likely to contain important elements of stress. Combating these adverse effects through minimising vulnerability and promoting resilience has the potential to impact positively on daily work experiences and to reduce post-mission morbidity. Although still much is to be learned about how individuals meet and adapt to adversity and stressful life events, this study contributes to understanding how resilience development can assist humanitarian workers to survive and thrive in their extremely challenging work environment.
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13]
Luthar, S. (2003) Resilience and vulnerability: adaptation in the context of childhood adversities. New York: Cambridge University Press. Hjemdal, O., Friborg, O., Stiles, T.C., Rosenvinge, J.H., & Martinussen, M. (2006) Resilience predicting psychiatric symptoms: a prospective study of protective factors and their role in adjustment to stressful life events. Clinical Psychology and Psychotherapy, 13, pp. 194-201 Paton, D., & Purvis, C. (1995) Nursing in the aftermath of disaster: orphanage relief work in Romania. Disaster Prevention and Management, 4, pp. 45-54 Grant, R. (1995) Trauma in missionary life. Missiology, 23, pp. 71-83 Corneil, W., Beaton, R., & Murphy, S. (1999) Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries. Journal of Occupational Health Psychology, 4, pp. 131-141 Garmezy, N. (1993) Children in poverty: resilience despite risk. Psychiatry, 56, pp. 127-136 King, L. A., King, D. W., Leskin, G., & Foy, D. W. (1995) The Los Angeles Symptom Checklist: a selfreport measure of Post-Traumatic Stress Disorder. Assessment, 2, pp. 1-17 Maslach, C., & Jackson, S. E. (1993) Maslach Burnout Inventory: Third Edition. Palo Alto, CA: Consulting Psychologists Press. Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989) Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56, pp. 267-283 Schwarzer, R., & Jerusalem, M. (1995) Generalised Self-Efficacy scale. In: J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: A user's portfolio. Causal and control beliefs. Windsor, UK: NFER-NELSON. Rotter, J. (1966) Generalised expectancies for internal versus external control of reinforcement. Psychological Monographs, 80, pp. 3-28 Scheier, M. F., & Carver, C. S. (1985) Optimism, coping, and health: assessment and implications of generalised outcome expectancies. Health Psychology, 4, pp. 219-247 Cutrona, C. E., & Russell, D. W. (1987) The provisions of social relationships and adaptation to stress. Advances in Personal Relationships, 1, 37-67
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[14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25]
Harding, T. W., Aarango, M. V., Baltazar, J., et al. (1980) Mental disorders in primary health care: a study of the frequency and diagnosis in four developing countries. Psychological Medicine, 10, pp. 231241 Block, J., & Block, J. (1980) The Role of Ego-Control and Ego-Resiliency in the Organisation of Behaviour. In: W. A. Collins (Ed.), The Minnesota Symposia on Child Psychology. Minneapolis: University of Minnesota Press. Connor, K., & Davidson, J. (2003) Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18, pp. 76-82 Hjemdal, O., Friborg, O., & Martinussen, M. (2001) Preliminary results from the development and validation of a Norwegian scale for measuring adult resilience. Journal of the Norwegian Psychological Association, 38, pp. 310-317 Fuher, R., Stansfeld, S.A., Chemali, J., & Shipley, M.J. (1999) Gender, social relations and mental health: prospective findings from an occupational cohort (Whitehall II study). Social Science & Medicine, 48, pp.77-87 Taylor, A. J., & Frazer, A. G. (1982) The stress of post-disaster body handling and victim identification work. Journal of Human Stress, 8, pp. 4-12 Cardozo, B. L., & Salama, P. (2002) Mental health of humanitarian aid workers in complex emergencies. In: Y. Danieli (Ed), Sharing the front line and the back hills: peacekeepers, humanitarian aid workers and the media in the midst of crisis. Amityville, NY: Baywood. Pearlin, L. I. (1991) The study of coping: an overview of problems and directions. In: J. Eckenrode (Ed), The social context of coping. New York: Plenum Press. Billings, A. G, & Moos, R. H. (1984) Coping, stress, and social resources among adults with unipolar depression. Journal of Personality and Social Psychology, 46, pp. 877-891 Rutter, M. (2003) Genetic influences on risk and protection: implications for understanding resilience. In: S. Luthar (Ed), Resilience and vulnerability: adaptation in the context of childhood adversities. New York: Cambridge University Press. Luthar, S., Cicchetti, D., & Becker, B. (2000) The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, pp. 543-562 Tugade, M. M., & Fredrickson, B. L. (2004) Resilient individuals use emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86, pp.320-333
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Helping professionals - the bless and the burden of helping Dârjan I., Tomita M. West University of Timisoara, Romania
[email protected]
Abstract The experimentation of stress, either acute or prolonged, major stressful events or daily annoying and disturbing little facts, is a risk factor in developing psychopathology. The helping professionals, dealing directly with the lives of those in need, are particularly prone to burnout and exhaustion and secondary traumatic stress. When you work directly with those who you help, your compassion affects you both in positive and negative ways. Also, in educational, therapeutic and remedial settings, there are often crisis situations which could escalate into a conflict rapidly. Though the existence of a conflict is not always a bad things, while solving it effectively could bring personal and professional growth, the stress also cause many psychological and interpersonal problems. By solving conflict successfully, you may also solve many underlying problems that it has brought to the surface and obtain unexpected benefits for your personal and professional development. Conflict management skills are very important assets for helping professionals and for helped people. A resilient factor for these professionals is theirs conflict management style, theirs ability to express assertively theirs emotions and to solve efficiently the conflictive situations. In this paper we intend to assess the impact of the life stressful events on the ability to cope with adverse circumstances and the relation between conflict management style and job satisfaction and burnout. Key-words: job satisfaction, compassion, burnout, conflict management style
Theoretical background Helping professions are at the same time and in various grades sources of great incentives and rewards, on one hand, and of desolating and sometimes devastating consequences and regrets. The rewarding and the consuming characteristics of these professions derive from the percent of different factors combing and defining job satisfaction.
1.1
Compassion: satisfaction and fatigue
Job satisfaction is an affective reaction to an individual’s work situation [1], it can be defined as an overall feeling about one’s job or career or in terms of specific facets of the job or career (e.g. compensation, autonomy, co-workers - Rice et al., 1991, in [1], and it can be associated with specific outcomes, for example efficacy, job persistence, turnover. In helping professions, job satisfaction can express the sense of a work well done, sens of self-efficacy [2], and positive impact on outcomes and on the lives of helped people. One model of explaining and investigating job satisfaction is the Job Demands-Resources Model (JD-R model) [3] is a theoretical approach that tries to explain the relationship between psycho-social working conditions and wellbeing. According to the JD-R model the work environment is characterized by two general categories: job demands and job resources [3]. The JD-R model was primarily developed to explain burnout and it is also useful to assess well-being at work and job satisfaction. Job demands include those physical, social, or organizational aspects of work that require continuing physical and/or psychological effort (i.e. cognitive or emotional). For that reason job demands are associated with physiological and/or psychological costs, like exhaustion. Job demands are not necessary negative, but they may become job stressors when those demands exceed the employees’ resources, generating job exhaustion and fatigue. Job demands of helping professionals include quantitative demands, time pressure, physical and emotional demands,) and demands for managing their own emotions. Job resources refer to physical, social, or organizational aspects of the job that (1) are functional in achieving work-related goals, (2) reduce job demands and the associated physiological and psychological costs, and (3) stimulate personal growth and development [3]. These resources can be found at the level of the
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organization at large, in interpersonal and social relations, in the ways of work organization, and in the specificity of tasks [4]. Job resources may foster employees’ growth, learning and development. The rewarding and the consuming side-effects of helping professions could be theorized in terms of Compassion Satisfaction (CS), representing the positive aspects of helping, and Compassion Fatigue (CF), representing the negative aspects of helping. Stamm (2009)[5] proposes a theoretical model of satisfaction and fatigue related with the work of the helpers. Professional quality of life incorporates two aspects, the positive (Compassion Satisfaction) and the negative (Compassion Fatigue). Compassion fatigue breaks into two parts. The first part concerns things such like exhaustion, frustration, anger and depression typical of burnout. Secondary Traumatic Stress is a negative feeling driven by fear and work related trauma.
1.2
Conflict and conflict management style
Considerable amount of research has been done into determinants of job satisfaction, fewer investigated the relations between job satisfaction and people’s conflict management style. Gray & Starke (1984) define conflict as the behavior express by a person or group with the intention to inhibit the attainment of goals by another person or group [6]. Blake and Mouton (1964) [7] developed a twodimensional conflict behavior model that is still referenced today. The two dimensional model of conflict includes: assertiveness, defined as a party’s attempt to satisfy his own concerns, and cooperativeness, defined as attempts to satisfy the concerns of another person [8]. There are four main types of conflict in organizations: intraindividual conflict, interindividual conflict, intragroup conflict, and intergroup conflict [9][10][11], and the main motives for conflict in organizations are competition for limited resources, the need for autonomy, divergences in objectives [12][13]. According to the Ruble and Thomas’ model of conflict behavior [8], employees have the ability to deal with conflict five different ways: by avoiding conflict all together (uncooperative and unassertive), by making too many exceptions (cooperative and unassertive), by competing anytime a conflict arises (assertive and uncooperative), or by collaborating (assertive and cooperative). Thomas-Kilmann’ model (1977) [8] also has a fifth mode, compromising, which serves as a middle ground for both assertiveness and cooperativeness (Figure 1).
Fig. 1: Modes of conflict management (Thomas-Kilmann, 1976)
The objectives of the study The purpose of this research was to investigate helping professionals’ degrees of job satisfaction in correlation with theirs style of managing conflict, determining if this style of managing conflict represents a factor of resilience, viewed here as the ability to bounce back, to cope, to adapt, and to develop social competence despite adversity. In this study we pursued two objectives. The first is a descriptive one: we tried to discover if there is a specific style of conflict management of helping professional from Romania as well as their professional satisfaction and burnout. For this objective we state the hypothesis that the helping professions have a specific culture of conflict management. Our hypothesis is that helping professionals engage a conflict management style based on collaboration instead of competition. The second objective was to analyze the relation between conflict management styles and professional satisfaction and burnout. Our hypothesis is that there are significant differences in professional satisfaction and burnout between professionals with different conflict management styles.
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Participants and instruments Our sample consists in 56 subjects in helping profession. Considering the gender distribution this sample is highly unbalanced with 91,2% female and only 8,2% male, but this distribution reflects the fact that helping professions in Romania are regarded as feminine. More specifically most of them are psychologists (46,4%) and teachers (35,7%) and the others are social workers (5,4%), medical staff (5,4) or others (6,4%). Their mean age is 35,8 years (s=7,62) and their experience is on average 9,8 years (s=6,33). Their clients are primary children (67,9%), but some are specialized in adults (7,1%) while others work with both children and adults (25%). In order to measure the conflict management style we used a 15 item scale [14] that measures five different styles (collaborating, avoiding, competing, accommodating and compromising). The Romanian version has a good reliability (α=.738). The scale is Likert type with five levels and three items for each style. We used Professional quality of life scale (ProQOL) in order to measure the professional burnout and satisfaction. The scale is Likert type with five levels and has 10 items for each of the three measured dimensions (compassion satisfaction, burnout and secondary traumatic stress). The Romanian translated version has reliability coefficients close to the original scale (α=.748, compassion satisfaction α=.825, burnout α=.574 and secondary traumatic stress α=.724).
Results The results showed that the preferred conflict management style is collaborating (mean=6,47, s=2,20) followed by a group of three styles (competing: mean =7,03, accommodating: mean=7,45 and compromising: mean= 7.87). The least frequent style is avoiding (mean= 9,40). However, the scale is allowing that a person to display two styles in the same time (the same score for two styles) so we compute the specific style for each subject. Only 41 subjects have a clear style of conflict management. From these group, 43,9% have a collaborating style, 31,7% have a competing style, and 14,6% have an accommodating style, while the avoiding and compromising styles have 4,9% each. From these results we could draw two conclusions: the helping professional are favoring an active, more assertive strategies of conflict management, either collaborative or competitive, instead of avoiding or compromising choices; although the mean of competing, accommodating and compromising styles are close, the last two are only secondary conflict management styles. Our hypothesis is only partially true. The professionals are more collaborative than competing, but the competing strategy is still important. We wanted to see if there are significant differences between different professionals and conflict management styles but the results were not supporting the hypothesis (chi square =17.97, p=.326). We have measured the level of professional satisfaction and fatigue (assessed by two subscales: burnout and secondary traumatic stress). Our sample could be described by moderate to low job satisfaction, but also only moderate to low burnout and secondary traumatic stress. So, 94.8% percent of the subjects present moderate job satisfaction. Only 3.4% percent of the respondents reported high job satisfaction, but, at the same time, only 1.7% percent perceives low job satisfaction. In terms of job fatigue, the subjects reported moderate to low burnout and secondary traumatic stress. Although 55.2% percent presented low burnout, it is interesting to notice that almost half of the sample (44.8%) experience moderate burnout. Secondary traumatic stress is experimented at moderate level by 34.5% percent of the subjects, while the main majority (65.6%) of the subjects has only low secondary traumatic stress. The results show that the majority of caring professionals are well adjusted to the workplace stress. One objective was to assess if the conflict management style has an influence on job satisfaction and fatigue. In order to test the hypothesis we applied one-way ANOVA procedure in order to see if there are significant differences between the samples with different conflict management style in terms of their level of burnout and secondary traumatic stress. The overall results show that there are no significant differences in satisfaction (F (4,36)=2.274, p=.08) or burnout (F(4,36)=1,187, p=.333), but there is a significant difference on secondary traumatic stress (F(4, 36)= 3,06, p=.029). However, the post hoc comparison didn’t highlight any significant differences between two groups, the most significant difference being between avoiding and collaborating styles.
Discussions and conclusions Our hypotheses were that helping professional have particular ways to manage conflicts and that these managing styles have an influence on job satisfaction and burnout. Our findings were that caring professionals are indeed using specific styles of managing conflicts. We have predicted that they are using collaboration and compromising styles, but our findings prove that the second style of managing conflicts is competing. Consistently with our predictions is the fact that they use assertive styles instead of strategies of ignoring and avoiding solving the conflicts.
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Our prediction that different conflict management styles are influencing the job satisfaction and levels of burnout was not supported. This doesn’t mean that the conflict management style has no effect, but in our sample we couldn’t highlight such relation. This could be the case that the level of burnout was quite homogenous as well as the conflict managing style. It is possible that those teachers which use avoidant strategies have a higher level of stress. The limited number of teachers with non-assertive style does not allow us to make a clear statement, but we think that the issue need further studies. Helping professionals tend to involve in assertive ways of solving conflict, either collaborative or competitive. They are not usually ignoring or avoiding ambiguous or controversial issues, because the core of their professions stands for clarifying problems and for findings efficient solutions and strategies for these objectives. In terms of job satisfaction and fatigue, although there is no impressive high job satisfaction, the moderate level of it, combined with moderate to low levels of burnout and secondary traumatic stress, allow us to conclude that this is a positive picture of investigated helping professionals. It means that the positive reinforcements they receive from their work exceed potentially bad outcomes (senses of inefficacy, job related irrational fears and worries). These results support the conclusions that these professionals are most likely good influences for their colleagues and their organizations, that they are liked by their clients/patients. This type of professionals benefits from engagement, opportunities for continuing education and career development [15]. These findings sustained the necessity of continuing education for helping professionals and the importance of their periodical (self)assessment and constant preoccupation for their well-being. For attaining these objectives, we consider that the supervision relations are crucial for these helping professionals, in order to debrief burdening issues and to learn how to understand, accept and solve work-related issues. Continuing education for helping professionals could focus on improving their abilities (for example, listening abilities) and on developing their assertive and collaborative ways of interactions and managing conflicts.
References: [1] [2]
[3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]
Kusma, B.; Groneberg, D.; Nienhaus, A.; Mache, S. (2012) Determinants of day care teachers’ job satisfaction, in Cent Eur J Public Health 2012; 20 (3): 191–198 Darjan, I. (2012). The impact of teachers’ systems of beliefs and sense of self-efficacy on managing students’ behaviour, in Mihaela Tomita (eds., 2012), „Violence amongst adolescences”, the Volume of the 3rd International Conference on Social Work Perspectives on the Quasi-Coercive Treatment of Offenders, Bologna: Medimond International Proceedings Demerouti E, Bakker A.B, Nachreiner F, Schaufeli WB. (2001). The job demands-resources model of burnout. J Appl Psychol.; 86(3):499-512. Bakker AB, Hakanen JJ, Demerouti E, Xanthopoulou D. (2007). Job resources boost work engagement, particularly when job demands are high. J Educ Psychol.; 99(2):274-84. Stamm, B.H. & Figley, C.R. (2009). Advances in the Theory of Compassion Satisfaction and Fatigue and its Measurement with the ProQOL 5. . International Society for Traumatic Stress Studies. Atlanta, GA, http://www.proqol.org/Home_Page.php Graham, S. (2009). The Effects of Different Conflict Management Styles on Job Satisfaction in Rural Healthcare Settings, in Economics & Business Journal: Inquiries & Perspectives, Volume 2 Number 1 October 2009, p. 71-85 Blake, R.R., Mouton, J.S. (1964). The Managerial Grid, Houston: Gulf Publishing Company Kilmann, R.; Thomas, K. W. (1977). Developing a Forced-Choice Measure of Conflict-Handling Behavior: The "MODE" Instrument". Educational and Psychological Measurement 37: 309. Riggio, R.E. (2009). Introduction to Industrial/Organisational Psychology. London: Pearson. Putnam, L. L. & Poole, M. S. (1987). Conflict and negotiation. In F. M. Jablin, L. L. Putnam, K. Roberts, & L. W. Porter (eds.), Handbook of organizational communication (pp. 503-548). Newbury Park, CA: Sage. Barge, J. K. (1994). Leadership: Communication skills for organizations and groups. New York: St. Martin’s Press. Greenhalgh, L. (1986). SMR forum: Managing conflict. Sloan Management Review, 27, 45-51. Owens, R. G. (1995). Organizational behavior in education (5th ed.) Boston: Allyn and Bacon. Falikowski, A. (2002). Mastering Human Relations, 3rd Ed. Pearson Education , Pearson Education http://www.pearsoned.ca Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org.
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The professional quality of life in resident psychiatrists Dragu C.1,6, Macsinga I.3, Dragu C., Papavă I.2,1, Tirintica R.4,6, Iuga G.5,6 1
„Eduard Pamfil” Psychiatric Clinic, Timișoara, ROMANIA “Victor Babeș” University of Medicine and Pharmacy, Timișoara,ROMANIA 3 Universitatea de Vest, Timisoara,ROMANIA 4 Clinica de Psihiatrie II, TarguMures, ROMANIA 5 Spitalul Clinic de Psihiatrie "Prof. Dr. Al. Obregia", Bucuresti, ROMANIA 6 Romanian Association of Psychiatry Trainees, AMRPR, ROMANIA
[email protected],
[email protected],
[email protected],
[email protected],
[email protected],ralucat
[email protected] 2
Abstract The psychiatric unit is often a place of despair, hopelessness and tremendous pain. Resident psychiatrists get in touch with this world and need to find abilities and resources to cope with that on a daily basis for their whole professional life. The aim of this study is to establish and measure the professional quality of life (compassion satisfaction, compassion fatigue) and identify potential professional coping methods in resident psychiatrists. Using a sample of 108 resident psychiatrists (73.14% women) from 3 training centers in Romania, 2 scales were applied. Results show significant negative correlations between burnout/secondary traumatic stress and addressing a therapist and significant positive correlations between secondary stress and self-medicating. Also, the evaluated professional quality of life changes during the training years of resident psychiatrists, first years residents showing higher level of burnout and secondary traumatic stress than final years residents. Keywords: compassion satisfaction, compassion fatigue, burnout, secondary traumatic stress, resident psychiatrists
Introduction Compassion fatigue, compassion satisfaction Compassion fatigue can be described as a disruptive, yet natural by-product of working with traumatized and troubled patients [1]. In 2010 Hudnall Stamm & al. describes symptoms such as exhaustion, frustration, anger and depression typical of burnout and a negative feeling driven by fear and work-related trauma called Secondary Traumatic Stress (Vicarious stress) [2]. But there is also a positive aspect of being in the position of helping patients: it is defined as compassion satisfaction. At this point burnout is considered to be a public health issue [3] and it is proven to determine serious health issues in those affected [4]. It has been of great interest for researchers, managers and clinicians in the last years due to its powerful impact on the quality of life of the individual, couple, family and organization.
Burnout in resident psychiatrists For medical professionals, the seeds of burnout may be planted as early as medical school. The literature to date seems to support the notion that there are a variety of factors during medical school that contribute to burnout in physicians, and that burnout is a phenomenon that develops cumulatively over an extended time period [5], [6]. Several studies have explored possible reasons for burnout in residency training. In these studies, residents report that time demands, lack of control over time management, work planning, work organization, inherently difficult job situations, and interpersonal relationships are stressors that may contribute to burnout, especially in the first year of training [7], [8], [9]. In 2004, Martini et al. did a unique study that compared burnout rates among the different specialties using the Maslach Burnout Inventory [10]. Psychiatry residents had a burnout rate of 40% and were noted to have additional stressors including fear and exposure to patient violence and suicide. [11] Often residents step in for the physician (their coordinating psychiatrist), the
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nurse, the social assistant, psychologist, therapist and become overloaded with paperwork, tests and physical activities.
Romanian resident psychiatrists Being a resident in Romania means being a part of a suffering and suffocated health system dominated by a culture of learned helplessness as a constant source of discontent, bitterness, and doubt for themselves and their patients.[12] This is the consequence of nearly 25 years of reform without continuity nor clear objectives, a constant underfinancing of the healthcare sector, poor planning and management of the health workforce, and lately an 4 immigration epidemic of healthcare professionals. [13]
Coping Interventions There are certain interventions that are effective in preventing compassion fatigue and thus encouraging compassion satisfaction. These interventions fall into 2 categories: workplace-driven interventions and individual-driven behavioral, social, and physical activities. More studies are needed to examine the applicability and utility of these interventions in resident physicians [14] (Ishak et al, 2009). This study explores some of the professional types of intervention the residents resident psychiatrist consider when confronted with burnout: addressing a therapist, consulting a psychiatrist, self-medication or joining a peer support group.
Objectives The aim of this study is to measure the professional quality of life in resident psychiatrists in different training centers across Romania, compare the results with the existing data of peers and establish the intervention of choice in dealing with burnout. Also, we aim to point out the significant correlations between the professional quality of life in resident psychiatrists and professional types of intervention the resident psychiatrist consider when confronted with burnout (addressing a therapist, consulting a psychiatrist, self-medicating or joining a peer support group) and the significant differences by gender, age, year of residency and training centers.
Material and method Participants and procedure This study was conducted in three different academic centers: Timisoara, TirguMures and Bucuresti. We applied two questionnaires to 120 resident psychiatrists. Only 108 individual answers were taken in the analysis (90 % of the tests distributed) as some of the scales were not returned. The testing phase was done individually by paper and pencil questionnaires. The environment in which the participants answered the questionnaires was a suitable one (without noise or disturbance factors). Therefore, the sample consists of 108 participants (73.14% women) with a mean age of 28 years. Participants in the study were junior year residents (first and second year) 54,4 % and senior year residents (3-rd, 4-rd and 5-th year). Anonymity and confidentiality were guaranteed to participants under the research code of conduct requirements specified in the Romanian legislation.
Instruments used The professional quality of life was measured with the (ProQOL) Version 5 (2009) 30 items questionnaire developed by B. HudnallStamm (2009). The ProQOL is the most commonly used measure of the negative and positive affects of helping others who experience suffering and trauma. The ProQOL has sub-scales for compassion satisfaction, burnout and secondary traumatic stress. The measure has been in use since 1995. There have been several revisions. The ProQOL 5 is the current version. The scale showed adequate reliabilities for our sample (alpha scale reliability .76). All items were scored on a 5-point Lickert scale, ranging from (1) “very rare” to (5) “very often.” The professional coping methods to job stress were assessed with 4 items that measure: addressing a therapist, consulting a psychiatrist, self-medicating or joining a peer support group. Participants were asked to score on a 5-point rating scale, ranging from 1 (“strongly disagree”) to 5 (“strongly agree”).
Results Data was processed in SPSS program 12.00. Pearson coefficients were determined between the measured variables and t test for mean differences was calculated. The results are shown in the tables below. The
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results have shown that there is a significant negative correlation between burnout, secondary traumatic stress and addressing a therapist as a coping intervention. Table1 – Pearson correlation coefficient between burnout and addressing a therapist
Therapy Burnout
Pearson Correlation
*
-.204
Sig. (2-tailed)
.034
N
108
Table 2 – Pearson correlation coefficient between secondary traumatic stress (STS) and addressing a therapist
Therapy STS
Pearson Correlation
-.166
Sig. (1-tailed)
.041
N
108
A significant positive correlation was revealed between secondary traumatic stress (STS) and selfmedicating. Table 3 – Pearson correlation coefficient between secondary traumatic stress (STS) and self-medicating (self-med)
Self-med STS
Pearson Correlation
.169
Sig. (1-tailed)
.04
N
108
Results show that first year residents have a significant lower level of burnout and Secondary Traumatic Stress than the last year residents. Table 4 – Differences of burnout/STS in first year residents and last year residents
Residency Burnout
STS
Mean
Std. Deviation
Group 1
20.98
4.536
Group 2
23.26
4.266
Group 1
16.24
4.416
Group 2
18.04
4.452
Sig. (2-tailed)
t-test
.009
-2.64
.039
-2.089
Group 1: year of residency 1,2 Group 2: year of residency 3, 4, (5) Also, age-related differences were highlighted: residents aged over 30 have a significant higher level of STS than the residents aged below 30.
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Table 5 - Differences of STS in residents aged over 30 and below 30 years
Age STS
Mean
Std. Deviation
Group 1
16.34
4.005
Group 2
18.59
5.235
Sig. (2-tailed)
t-test
.0179
-2.428
Group 1: aged below 30 Group 2: aged over 30 Results show that residents from Timisoara declare a significant higher level of compassion satisfaction than the residents in Bucuresti. Also, residents in Timisoara would chose consulting a psychiatrist as a coping intervention when confronted with burnout. There are no significant differences between residents studying in Timisoara and Tirgu Mures or the ones in Bucuresti and Tirgu Mures. Table 6 Differences in level of compassion satisfaction and consulting a psychiatrist between Bucuresti and Timisoara training centers Training center Satisfactie
Psychiatrist
Mean
Std. Deviation
Bucuresti
34.93
5.614
Timisoara
37.57
4.727
Bucuresti
3.20
1.271
Timisoara
3.91
1.164
Sig. (2-tailed)
t-test
.05
-1.980
.022
-2.331
Discussions Our study shows that Romanian resident psychiatrists experience different levels of burnout and secondary traumatic stress but addressing a therapist is not the coping intervention they would consider. Although emotional awareness and emotional management abilities, time management, relaxation response techniques, focused breathing, meditation methods, mindfulness techniques, all of which are subjects of psychotherapy, have shown encouraging results in dealing with and preventing burnout [15], [16] the group we studied does not see addressing a therapist as a valid option. We can assume there is a matter of trust in the abilities of a therapist or a lack of trust in the power of the mentioned coping intervention. They nevertheless trust their own ability to use the proper medication if confronted with burnout syndrome. First year residents show a higher level of burnout and STS that last year residents. This aspect has been proven by other studies, where being in one's first year in residency was associated with increased likelihood to meet burnout criteria. [10] Residents in Timisoara have shown a higher level of compassion satisfaction than those in Bucuresti but not than those in Tirgu Mures. We can think of certain differences in the local culture, organization or community.
Conclusions Current studies show that workplace-driven interventions like developing stress-reduction programs or increasing staff awareness of burnout and individual-driven behavioral, social, and physical activities are most efficient in dealing with professional stress. Our study shows that Romanian resident psychiatrist who are confronted with burnout would rather chose self-medication as a coping intervention. Raising awareness of burnout and multiple coping interventions for future psychiatrist is important for their own well-being but also to provide safe, high-quality patient care and should be considered when tailoring residency programs.
References [1]
Figley, Ch. (1995). Compassion fatigue.Coping with Secondary traumatic stress in those who treat the traumatized.p XIV
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[2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [16] [17] [18] [19] [20]
Hudnall Stamm, B. (2010), http://www.proqol.org Devi, S. (2011). Doctors in distress. The Lancet, 377, 454.http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611601451.pdf Toker, S., Melamed, S., Berliner, S., Zeltser, D., &Shapira, I. (2012). Burnout and Risk of Coronary Heart Disease: A Prospective Study of 8838 Employees. Psychosomatic Medicine, 74, 840-847. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, Shanafelt TD (2006). Personal life events and medical student burnout: a multicenter study. Acad Med; 81(4):374-384. [PubMed] Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. (1997. A longitudinal study of students' depression at one medical school. Acad Med; 72(6):542-6. [PubMed] Cohen JS, Patten S. (2005). Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ. 22; 5:21. [PMC free article] [PubMed] Purdy RR, Lemkau JP, Rafferty JP, Rudisill JR. (1987). Resident physicians in family practice: who's burned out and who knows?Fam Med; 19(3):203-8. [PubMed] Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V(2003). Occupational stress and burnout in anaesthesia.Br J Anaesth; 90(3):333-7. [PubMed] Martini S, Arfken CL, Churchill A, Balon R(2004). Burnout comparison among residents in different medical specialties.Acad Psychiatry. 28(3):240-2. [PubMed] Deahl M, TurnerT (1997). General psychiatry in no-man's land.Br J Psychiatry. 171():6-8. [PubMed] Spânu F,Băban A, Bria M., Dumitraşcu, D. L. (2012). What happens to health professionals when the ill patient is the health care system? [ORCAB Special Series] British Journal of Health Psychology. doi:10.1111/bjhp.12010 Todorova IBăban, A., Alexandrova-KaramanovaA.,Bradley, J. (2009). Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania. International Journal of Public Health, 54, 1 – 11. doi:10.1007/s00038-009-8040-6 IsHak. W, Lederer. S, Mandili C,Seligman L.Vasa M, Ogunyemi D, Bernstein C (2009). [15] Burnout During Residency Training: A Literature Review Burnout During Residency Training: A Literature Review Burnout During Residency Training: A Literature Review Burnout during residency training. A literature review.J Grad Med Educ.; 1(2): 236–242. Gewertz B. L. (2006). Emotional intelligence: impact on leadership capabilities. Arch Surg.;141(8):812– 814. [PubMed] Seligman L. (2009). Physicians heal thyself. Available at www.transformationconsultinginc.com
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Towards an ecologically based intervention to grow professional resilience Hudson C., Hart A., Dodds P. 1
School of Health Sciences, University of Brighton, UK
[email protected],
[email protected],
[email protected]
Abstract Despite high levels of stress and burnout [1] and the recently reported, ‘compassionate care’ crisis [2], professional resilience as a strand of resilience research has received relatively little attention. Staff well-being is an antecedent to patient care [3] and this paper will explore the feasibility of a professional resilience intervention, to ‘buffer’ the effect of work related stress [4]. Resilience research has begun to apply resilience-focused concepts to supporting professionals in various fields including education [5, 6], social work [4, 7], nursing and midwifery [8, 9, 10, 11 & 12]. However, much of this work is not sufficiently grounded in ecological theories of resilience, as described by Ungar [13]. Adamson, Beddoe and Davys [14] offer a conceptual framework of resilience in social work that is ecologically based, but this does not extend to an intervention, nor has it been applied to other professional groups. This paper will present work in progress of a doctorate study, which links with the resilience work (http://www.boingboing.org.uk/) and the Health and Social Inequalities research programme, co-ordinated by Professor Angie Hart and collaborators. The aim of the thesis is to answer the question, ‘What are the best approaches to support professional resilience?’ This paper will draw on the resilience literature across different professional groups, to define the construct of professional resilience, the nature of adversity and to propose an ecologically based intervention to grow professional resilience, otherwise termed as the, ‘Growing Resilience Intervention Tool’ (GRIT). Keywords: Resilience, work-based, intervention, novice health professional, preceptor, support.
Introduction Professional well-being has been inextricably linked to service user outcomes [3]. In the current ‘compassionate care’ crisis [2] professional resilience features as an important attribute. Research to explore an ecologically based approach to support novice professionals, otherwise termed as the, ‘Growing Resilience Intervention Tool’ (GRIT) is an important and timely contribution to the resilience literature. The challenge to reviewing the literature is that over time, any concept analysis of resilience becomes dated [15]. Previous studies on professional resilience have tended to use an individualistic perspective. More recently, recommendations for increasing resilience in the health care curriculum [16] focus on a combination of individual and contextual factors and the interplay between individuals and the context is strongly emphasised [4, 17, 18]. Learnt adaptation over a period of professional life may inform an early career intervention to grow professional resilience. Adamson, Beddoe and Davys [14] offer a construct of resilience from the field of social work that is ecologically based (p 9). In this model, professionals can explore the interplay between the self (intrinsic) the practice context (extrinsic) [14] and the ‘space inbetween’, identified as mediating factors, of which ‘supervision and peer support’ is one. This paper draws on the ‘space’ inbetween to determine whether the, ‘hypothesised mediators’ [19] are i) evident in other professional groups and ii) to determine the efficacy of developing an intervention (GRIT) to support ‘supervision and peer support’ in the preceptorship period.
1.1
Resilience across professional groups
Professional resilience is defined as, ‘the ability to maintain personal and professional wellbeing in the face of on-going work stress and adversity’ [18 p 61]. In a review of resilience literature across five professional groups (nurses, social workers, psychologists, counsellors, medics) McCann et al [18] identified numerous individual and contextual mechanisms and distinguishing features. Only gender (more specifically, being female) and maintaining a work-life balance have been found to consistently relate to resilience across all the
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professional groups studied. However, the complexity of comparing different groups and studies with different definitions and measurements of resilience has been acknowledged [18]. McCann et al’s [18] study reveal similar findings to those featured in Adamson et al’s [14] construct of resilience. Worklife balance which resides in the ‘space’ in between [14] is a defining attribute of professional resilience. Beliefs and spirituality reside predominantly in the self and are featured elsewhere [9]. Other dominant factors that relate to resilience in four of the five disciplines [18] are associated with the mediating factors in the ‘resilience matrix’ [14]: Laughter and humour fits with coping behaviours; self-reflection and insight as part of supervision and peer support, and professional identity is also prevalent in other studies [14, 20]. Factors predominantly reside in the mediating space, rather than the individual which fits with an ecological approach to professional resilience. McCann et al [18] also recognise a number of contextual factors which are predominantly relational, categorised in both personal (extrinsic to work) and professional. Of these, the dominant professional relational categories relate to i) work colleagues and mentors/role models and ii) client connectedness. This study will focus on the first category, intervening in co-worker/preceptor support. Studies that enhance client connectedness and its influence on resilience, is an area for future work. Adamson et al’s [14] construct of resilience is found to be congruent with the professional context, and to a number of professional groups [18]. Limited conclusions can be drawn about the transferability of these findings to other professions such as teachers, and this is another área for future work.
Growing Professional Resilience An ecologically based resilience intervention relies on an appreciation of the i) the exposure of adversity and ii) the positive adjustment outcomes [19]. Sensitisation to stressors during professional development in the pre-qualifying years may influence novice professionals’ resilience but this requires more longitudinal studies. Common stresses at the professional novice phase are recognised [21] and a period of preceptorship has been widely implemented in health and social care professionals to buffer the effect of early career stress [22]. However, evaluation of preceptorship has largely focused on the preceptees experience [23] and less on the support needs of preceptors to enact the role [24]. This paper will present evidence that supports the need to grow professional resilience (GRIT) by intervening in the preparation and support of preceptors.
1.1
The Adversity
There are a number of studies predominantly from Australia, New Zealand and the UK, which report adversity in the practice learning environment experienced by student nurses, including incivility and bullying [25, 26, 27], and some cases of overt racism by qualified staff and some non-professional staff. Students were seen to counteract the oppression, and as such learners’ resilience was evident. The question remains as to i) Why this ‘oppression’ manifests itself, and to determine ii) what enables some students to independently and collectively resist the ‘othering.’ Whilst acknowledging that this is not the case for all students, practice experience within the curriculum is reported to cause students the most stress. Overall levels of ‘caseness’ (stress) reported at 43% in social work students (n=240) [7] calls for effective resilience models, and attempts to build resilience in the pre-qualifying curriculum are being implemented [28]. McAllistair and McKinnon [16] make recommendations for embedding resilience and specific interventions in professional education to grow resilience have begun to emerge [10,11, 29].
1.2
Newly qualfied
These studies suggest that novice professionals may have been exposed to signifcant adversity during earlier practice experiences. Using a ‘Growing Resilience Intervention Tool’ (GRIT) at the outset of a professional career, is valid given the high levels of stress and role adjustment during this time [30, 31]. Experiences of ‘covert’ horizontal violence, including some significantly distressing incidents are reported at the early career phase [32]. Similar patterns of non allegiance with novice midwives, as with the women being cared for, reveals the negative sequelae on service users [33]. Interestingly, only a minority of participants reported positive outcomes in relation to the experiences described. These included, more assertiveness, inner strength, reassurance gained from support of other colleagues [32]. Vulnerable groups were identified, as follows: newly qualified and inexperienced professionals, those in poor health, or staff with roles which cross over different work environments [34, 32]. Ungar [35] emphasises that measuring resilience relies on a clear definition of what it is, but acknowledges that ambiguity exists. These studies would suggest that professional resilience is exceptional levels of functional adaptation in circumstances of heightened risk exposure for a very small minority. For the
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most vulnerable reported in these studies, professional resilience during early professional maturation is more aligned to normative levels of coping in exceptionally difficult circumstances.
1.3
The Context
Despite instigating prevention measures at an organisational level, including policies of zero tolerance, assertiveness training and encouraging the reporting of incidents, inappropriate behaviour and the existence of a hostile work context was sometimes tolerated in order to meet service demands [33]. It would appear that organisational processes and structures that exist are not always protective. ‘Oppressors’ are allowed to ‘thrive’ and shape a hostile work environment, at the expense of vulnerable individuals. Perpetrators of bullying were found not only to be from management positions but from ther colleagues also, includng a minority of preceptors themselves [32]. Protective self-management, leading to self-withdrawal, and a perpetuation of a culture in which students can feel abandoned and unsupported by colleagues has been postulated [8] and Ungar warns against turning ‘oppressors’ into victims [35]. Preceptors narratives are under-reported in the literature. The need for preparation and organisational support for preceptors is advocated [36]. Choice in enacting the role is often over-ridden by organisational and professional requirements, and feelings of powerlessness have been reported by mentors supporting learners in practice [37]. The need to feel valued by the organisation and recommendations for a ‘managerial support framework’ [36] implies an ecological framework.
Growing professional resilience intervention tool (grit) Despite studies recognising the challenges for preceptors, areas of concern continue to be unresolved, such as role strain caused by workload fatigue, lack of time and value afforded to the role [38]. Indeed, supervisors such as preceptors have been found to have high levels of stress which may compromise their ability to identify stress in novices as well as provide support [39].
1.1
Preceptor connectedness
Recommendations to strengthen resilience in nurses through strategies and mentorship programmes have been reported [9]. Preceptors who share and practice ‘resilient moves’ [40] as well as role model a positive identity and share sources of social support, coping skills and connectedness in the workplace have benefits in preparing pracititoners for the early stages of a professional career [41]. Exploration of what causes, ‘distal space’ in work contexts and conversely, supportive models that mitigate against organisational constraints, will inform an ecologically based intervention (GRIT) to grow professional resilience. Interventions to support preceptors to manage the ‘space’ [14] between their own context and practice experiences, and that of novice professionals fits with Ungars’ [13] definition of resilience as the interplay between the individual and the environment as a ‘place of possibility’ [42]. Acknowledgement of the importance of student: supervisor connectedness [42], positive supervision [43] and reciprocity gained through the relationship [44, 45] exist. In the early career phase, novices need ‘relational connection’ which includes: role models who practice in congruence with students’ idealized view [31], positive peer relationships and continuity between clients and preceptors [46]. The doctorate study will specifically identify the pre-requisites for supportive preceptor preparation, as well as the preserving and protective processes to enhance the ‘relational space’ [47] between preceptors and novices. This paper strengthens the argument for an ecologically based intervention that enhances the ‘Supervisory interpersonal interaction’ [48]. Recognition of peer and supervisory support features in the professional resilience literature [14,18]. The doctorate study will develop a GRIT to enhance preceptor connectedness and will apply Ungars [17] four principles of an ecological resilience construct decentrality, complexity, atypicality and cultural relativity to further inform the professional resilience literature.
Conclusion In summary, this paper offers a review of the contextual issues impacting on novice professional resilience. There is evidence of adversity, in terms of incivility and ‘horizontal violence’ impacting on novice professional resilience and in particular the complex relational and contextual aspects at play. Enhanced connectedness through the preceptorship relationship has been suggested as the basis of a GRIT. Further work includes using an inequalities lens [49, 51] and in particular exploring the psychodynamics mechanisms including the, ‘Effect of the professional ego’ (p502) [50]. In this respect, remuneration for preceptors; racism and bullying experienced by some novices and other inexperienced staff, those in poor health, and others can be viewed with an inequalities imagination [51].
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Exposure to incivility in the workplace, has been predominantly described in studies on pre-qualifying and novice nurses and midwifes. An ecological intervention to avoid the ‘sink or swim’ [52 p382] phenomena will be extended to other professional groups and aim to counteract the organisational aggression, strengthen influential mediating factors and bolster individuals’ positive connectedness. Growing professional resilience, using a GRIT in the supervisory relationship could have wide and far reaching application beyond the health and social care arena, extending to newly qualified teachers and beyond.
References [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24]
Aiken, L.H et al. (2012) Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. British Medical Journal. Accessed online [27.06.12] http://www.bmj.com/content/344/bmj.e1717.pdf%2Bhtml Francis report. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive summary. London: The Stationery Office Maben, J. R, Peccei, M, Adams, G, Robert, A, Richardson, T, Murrell and E, Morrow. (2012) Exploring the relationship between patients’ experiences of care and the influences of staff motivation, affect and well being. Final report. NIHR Service Delivery and Organisationa programme: London Collins, S. (2007) Social workers, resilience, positive emotions and optimism. Practice 19(4), pp. 255– 69. Beltman, S. C. Mansfield, and A. Price. (2011) Thriving not just surviving: A review of research on teacher resilience. Educational Research Review. 6, pp. 185–207. Cornu. R.L. (2009) Building resilience in pre-service teachers. Teaching and Teacher Education 25 (2009), pp. 717–723. Kinman, G. and L. Grant. (2011) Predicting stress resilience in trainee social workers: the role of emotional competencies. British Journal of Social Work, 41(2), pp. 261-275. Hunter, B and L.Warren. (2013) Investigating Resilience in Midwifery: Final report. Cardiff University: Cardiff. Jackson, D. A, Firtko and M, Edenborough. (2007) Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review. Journal of Advanced Nursing. 60(1) pp. 19. McDonald, G. D, Jackson, L. Wilkes and M. Vickers. (2011) A work-based intervention to promote personal resilience in nurses and midwives. Nurse Education Today. 32(4), pp. 378-384. McDonald, G. D, Jackson, L. Wilkes and M. Vickers. (2013) Personal resilience in nurses and midwives:Effects of a work-based educational intervention. Contemporary Nurse. 45(1), pp. 134-143. Foureur, M., K. Besley, G. Burton, N. Yu and J.Crisp. (2013) Enhancing the resilience of nurses nad midwives: Pilot of a mindfulness- based program for increased health, sense of coherence and decreased depression, anxiety and stress. Contemporary Nurse. 45(1), pp. 114-125. Ungar, M. (Ed.) (2012)The social ecology of resilience: A handbook. New York, NY: Springer. Adamson. C, L. Beddoe and A. Davys. (2012) Building Resilient Practitioners:Definitions and Practitioner Understandings. British Journal of Social Work.pp. 1–20. Gillespie, B. M., W, Chaboyer, M, Wallis, & P, Grimbeek. (2007) Resilience in the operating room: Developing and testing of a resilience model. Journal of AdvancedNursing, 59, pp. 427–438. McAllister, M. and J. McKinnon. (2009) The importance of teaching and learning resilience in the health disciplines: A critical review of the literature. Nurse Education Today. 29: pp. 371-379. Ungar, M. (2011) The Social Ecology of Resilience: Addressing Contextual and Cultural Ambiguity of a Nascent Construct. American Journal of Orthopsychiatry. 81(1), pp. 1–17. McCann, C. M., E. Beddoe, K. McCormick, P. Huggard, P.S. Kedge, C. Adamson, & J Huggard. (2013) Resilience in the health professions: A review of recent literature. International Journal of Wellbeing. 3(1), pp. 60-81. Luthar, S. S., & Cicchetti, D. (2000) The construct of resilience: Implications for interventions and social policies. Development and Psychopathology, 12(04), pp. 857-885. doi:10.1017/S0954579400004156 Beddoe, L., A. Davys, and C. Adamson. (2013) Educating resilient practitioners. Social Work Education. 32(1), pp. 100-117. Skovholt, T.M. and M. Trotter-Mathison. (2011) The Resilient Practitioner Burnout prevention and selfcare strategies for Counsellors, Therapists, Teachers and Health Professionals. 2nd ed. London:Routledge Department of Health (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals. London, Department of Health. www.networks.nhs.uk/nhs-networks/ahp-networks/.../dh_114116.pdf (accessed 14 June 2013)
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[25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50]
Marks-Maran, D., A, Ooms,J, J, Tapping, S, Muir, S, Phillips, and L, Burke. (2012) A preceptorship programme for newly qualified nurses: a study of preceptees' perceptions. Nurse Education Today. http://dx.doi.org/10.1016/j.net.2012.11.013. Muir, J. A, Ooms, J,Tapping, D, Marks- Maran, S Philips and L Burke. (2013) Preceptors' perceptions of a preceptorship programme for newly qualified nurses. Nurse Education Today. 33, pp 633-63825 Randle (2003) Bullying in the nursing profession. Journal of Advanced Nursing 43, pp. 395–401. Thomas, J. (2013) Finessing Incivility: How student nurses respond to issues concerning their status and learning during practice: A grounded theory. PhD Thesis Jackson, D. M.Hutchinson, E. Bronwyn, J. Mannix, K.Peters, R.Weaver and Y. Salamonson. (2011). Struggling for legitimacy: nursing students’ stories of organisational aggression, resilience and resistance. Nursing Inquiry. 18(2), pp. 102–110. Grant, L. and G. Kinman, (2012). Enhancing Wellbeing in Social Work Students: Building Resilience in the Next Generation. Social Work Education, 31(5), pp. 605-621. Gu, Q. and C. Day, (2013) Challenges to teacher resilience: conditions count. British Education Research Journal pp. 1-23. Duchscher, J.E.B., (2009) Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses. Journal of Advanced Nursing 65 (5), pp. 1103–1113. Ferguson, L. M. (2011) From the perspective of new nurses: What do effective mentors look Like in practice? Nurse Education in Practice. 11, pp. 119-123 McKenna B G , N. A, Smith S. J, Poole and J. H, Coverdale (2003) Horizontal violence: Experiences of registered nurses in their first year of practice. Journal of Advanced Nursing, 42(1), pp. 90--96. 10.1046/j.1365-2648.2003.02583.x Curtis, P, Ball, L and M. Kirkham. (2006) Bullying and horizontal violence:Cultural or individual phenomena? British Journal of Midwifery. 14(4)pp. 218-221. Ball L, Curtis P, Kirkham M. (2002) Why do midwives leave? RCM: London. Ungar, M (2004) A Constructionist Discourse on Resilience: Multiple Contexts, Multiple Realities among At-Risk Children and Youth. Youth Society. 35:341 Whitehead, B. O, Pat, D, Holmes, E. Beddingham, M. Simmons, L. Henshaw, M. Barton and C, Walker. (2013) Supporting newly qualified nurses in the UK: A systematic literature review. Nurse Education Today. 33 (4), pp. 370-7. Morton, S. (2013) What support do Health visitor mentors need? Community Practitioner. 86(8), pp. 3235. Rooke, N (2013) An evaluation of Nursing and midwifery sign off, new mentors and nurse lecturers’ understanding of the sign off mentor role. Nurse Education in Practice. pp. 1-6. Wallbank, S. (2010) Effectiveness of individual clinical supervision for midwives and doctors in stress reduction: findings from a pilot study. Evidence Based Midwifery 8(2)pp. 65-70. Hart, A., D. Blincow, and H. Thomas. (2007) Resilient Therapy. Working with children and families. Hove: Routledge. Thrysoe, L. L Hounsgaard, N. Bonderup Dohn and L. Wagner. (2010). Participating in a community of practice as a prerequisite for becoming a nurse: Trajectories as final year nursing students. Nurse Education in Practice. 10, pp. 361-366. Gillespie, M. (2005) Student–teacher connection: a place of possibility. Available online http://web.b.ebscohost.com.ezproxy.brighton.ac.uk/ehost/pdfviewer/pdfviewer?vid=3&sid=ce0fc17c0082-46eb-b3ba-f71da65fe3f2%40sessionmgr114&hid=123 Accessed: 06.02.14 Morley, M (2009) An evaluation of a preceptorship programme for newly qualified occupational therapists. British Journal of Occupational Therapy. 72(9), pp. 384-392. Mason, J. and S. Davies. 2013. A qualitative evlaution of a preceptorship programme to support newly qualified midwives. Evidence Based Midwifery. 11(3), pp. 94-98. Haydock D. J, Mannix and J, Gidman. (2011). CPT’s perceptions of their role satisfaction and levels of professional burnout. Community Practitioner. 84(5), pp. 19-23. Fenwick, J, A. Hammond, J. Raymond, R. Smith, J. Gray, M. Foureur, C. Homer and A. Symon (2012) Surviving, not thriving:a qualitative study of newly qualified midwives’experiences of their transition to practice. Journal of Clinical Nursing. 21, pp. 2054-2063. Beddoe, L. (2010). Surveillance or Reflection: Professional Supervision in ‘the Risk Society’. British Journal of Social Work. doi: doi:10.1093/bjsw/bcq018 Mor Barak, M., Travis, D.J., Pyun, H. & Xie, B. (2009) The Impact of Supervision on Worker Outcomes: A Meta-analysis. Social Service Review, 83 (1),pp. 3-32. doi: 10.1086/599028 Hart, A. and R. Beaver (2013) Evaluating resilience-based programs for schools using a systematic consultative review. Journal of Child and Youth Development. 1(1), pp. 27-53.
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[51]
Hart, A. and Freeman, M. (2005). Health “care” interventions: Making health inequalities worse, not better?. Journal of Advanced Nursing, 49(5), pp. 502–512. [52] Hall, V. and A. Hart., (2004). The use of imagination in professional education to enable learning about disadvantaged clients. Learning in health and social care, 2004. 3(4), pp. 190-202. [53] Hughes, A.J. and D. M. Fraser. (2011) ‘SINK or SWIM’: The experience of newly qualified midwives in England. Midwifery 27, pp. 382-386.
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Resilience and public administration: Implications for the “New Political Governance” in Canada Milley P.1, Jiwani F.2 1
University of Ottawa (CANADA) Carleton University (CANADA)
[email protected],
[email protected] 2
Abstract We live in an increasingly interconnected, complex world. Concerns have been raised about the capacity of governments to cope with the disruptions that emerge out of this context. The concept of resilience offers a credible strategy, but its potential contribution in light of increased complexity in governance contexts has not been widely researched. This article targets this gap in the knowledge base of public administration. It presents a theoretical perspective on resilience based on key concepts from an ecological model derived from complex adaptive systems theory. That lens is used to examine the New Political Governance in Canada, a set of reforms that have allowed ministers and political staff to increase their influence and direction over the public administration. The push for greater political control represents a particular kind of response to increased complexity. The analysis provided suggests there are numerous weak spots in this new governance strategy, which has the potential to reduce anticipative and adaptive capacities in government and society and to cause a ‘regime shift’ in the functioning and integrity of the public administration that could destabilize and make more vulnerable the broader system of public governance. Keywords: Resilience, Public Administration, Governance, Panarchy, Complex Adaptive Systems, Canada.
Introduction Since the 1980s, governments in Canada and elsewhere have helped shape a powerful round of globalization processes, extending a modern trend with origins in the nineteenth century [1][2]. During this same period, human populations have grown and become more diverse and mobile. Modern information and communication technologies have connected people like never before, creating densely networked societies.[3] We now live in an interconnected world, characterized by complex interdependencies in political, economic, trade, finance and technical systems, among others [4]. Questions have been raised about how governments should respond in this complex environment [4]. Concerns have been expressed about their capacity to cope with the shocks, disruptions and surprises that seem to emerge with worrying frequency, and about their ability control events or to stop negative effects from cascading across interdependent systems and networked societies [4][5]. In this unpredictable context, the concept of resilience—that is, the capacity to proactively and reactively cope with shocks, surprises and adversity—has the potential to contribute important insights for scholars and practitioners in public administration. It offers an intuitively credible strategy for preparing for, dealing with, and adapting to disruptions and adversity [6]. While resilience is not a new topic in public administration, it has not been widely researched and its potential contribution in light of increased complexity in governance contexts has barely been broached. In what follows, we address this gap in the knowledge base of public administration. We first present a theoretical perspective on resilience based on key concepts from Panarchy theory [7][8], an ecological model based in complex adaptive systems theory. We argue this explicit use of ideas from a complexity science provides added heuristic value for conceptualizing resilience in contemporary public administration in its contemporary context. Then we use the concepts to examine the implications for resilience in public administration in light of the rise of the ‘New Political Governance’ (NPG) in Canada and other jurisdictions governed with a Westminster system of parliamentary democracy. The NPG is an ‘ideal type’ (in the Weberian sense), coined by Aucoin [9], to describe the predominant features of contemporary governance. Key among these are: “i) the integration of executive governance and the continuous campaign, ii) partisan-political staff as a third force in governance and
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public administration, iii) a personal politicization of appointments to the senior public service, and iv) an assumption that public service loyalty to, and support for, the government means being promiscuously partisan for the government of the day’’ [9 p.179]. We argue this move by ministers and their political staff to exert more influence and direction over the public administration comes as a particular kind of response to increased complexity in the broader governance context—it is an effort to control that context. Our analysis suggests that, from the point of view of complexity-based resilience theory [10], there are numerous weak spots that stem from this NPG strategy. We conclude the paper with some tentative guidance for public administrators in jurisdictions that feature NPG characteristics, along with some thoughts about future research directions.
Resilience and Public Administration – Setting the Stage The idea of resilience has had a presence in the public administration subfields of emergency preparedness and response [11] and natural resource management [12] since the late 1980s. It was introduced into the ‘mainstream’ in the 1990s when Hood [13] highlighted it as an undervalued concept that conflicted with ‘efficiency’ as the predominant administrative interest. Resilience gained some prominence in the mid-2000s in response to the shocks and crises (e.g., the 9/11 terrorist attacks, financial crises) that affected public governance in that period [14] and the recognition that new strategies were needed to govern in an era of heightened uncertainty and complexity [10][15]. There have been two related lines of inquiry with respect to resilience. One has concentrated on understanding how governments can better anticipate, plan and prepare for adversity to prevent or mitigate harm. The other has focused on understanding how to better respond through learning, experimentation and innovation [13][16]. The emphasis of the former line of thought has been on maintaining stability and helping people, communities, organizations or systems to ‘bounce back’ to a prior state of ‘normalcy’ [6]. The focus of the latter has been on promoting ongoing adaptations to help them remain ‘functional’ (and thus resilient) during and after adverse events [17]. A more synthetic way of understanding the relationships between anticipation and adaptation, stability and change are needed in an era of increased complexity [4]. The Panarchy model [7][8], developed to understand resilience in complex adaptive systems, offers promise in gaining a more holistic understanding of how resilience works. Here we offer our interpretation of select components of this model, clarifying with examples in public administration settings. Throughout, our background assumption is that public administration can be thought of as a sub-system (itself composed of smaller sub-systems) that is connected to a broader set of complex adaptive systems (e.g., social, economic, ecological systems). At the core of the Panarchy theory is the adaptive cycle. It describes four commonly occurring phases of change that occur in the sub-systems that comprise a complex adaptive system. These phases include: 1) exploitation and growth, 2) conservation, 3) release, and 4) reorganization (see Fig. 1-adapted from [8]). The transition from phases (1) to (2) consists of a relatively slow, incremental process of growth and accumulation of a particular kind of ‘capital’ (e.g., consolidation of political power and alignment of administrative capacities and resources with policy priorities). The transition from phases (2) to (4) usually begins with some form of internal or external ‘disturbance’ (e.g., political or administrative missteps, social unrest, or economic shocks), creating the need for rapid response and change.
Fig. 1: The Adaptive Cycle
If anticipative capacities are in place before the needed transition from (2) to (4), it may be possible to take actions to mitigate harm or to stop negative effects from spreading. If the adaptive capacities are in place, it
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may be possible for those affected to refashion and renew themselves so they, and the system of which they are a part, retain their fundamental functions and integrity (Walker et al., 2004). If anticipative or adaptive capacities are lacking, the transition from (2) to (4) may not result in renewal. Instead, the actors and/or the system may go through a ‘regime shift’ the outcomes of which cannot be readily predicted. Such dramatic, qualitative changes may be adaptive, maladaptive or catastrophic [8][18]. For example, one or more of the basic structures or functions of “good government” (e.g., democratic institutions, rule of law, transparency, accountability, evidence-based public policy, etc.) may be eroded, resulting in a collapse of integrity in the governance system. Two types of situations can make the adaptive cycle maladaptive. The first are “rigidity traps” [8 p. 400]. These develop when systems are so tightly aligned and controlled internally that they become ‘brittle’ and, thus, subject to failure when confronted with exogenous shocks or disruptions. Such systems may appear resilient because they have endured pressures for change, often for long periods of time; however, their capacity for responding in agile or flexible ways has been “smothered” [8 p. 400] as any self-organizing potential (e.g., discretionary decision-making, initiative) has been squeezed out of them. Autocratic regimes and classical bureaucracies are examples [7]. The second maladaptive situation consists of “poverty traps” [8 p. 400]. These appear when diversity in a system has been largely eradicated, reducing variety and, with it, the capacity to generate novel insights and options to support renewal [14]. An example would include jurisdictions in which a focus on ‘austerity’ or ‘efficiency’ has reduced investments in policy capacity and policy innovation. Rigidity and poverty traps can affect both anticipative and adaptive processes [19], potentially reducing resilience on two fronts. For example, ideological, partisan or bureaucratic ‘filtering’ of information, evidence or insights can reduce the ability of elected officials and administrators to perceive and acknowledge certain risks and vulnerabilities [20]; while, centralized control structures, reinforced with standard operating procedures and a culture of compliance (or fear), can reduce the capacity for deriving novel options and exploiting them when needed [4][14]. Another key concept in the Panarchy model is its reinterpretation of hierarchy, which opens up a perspective on how anticipation, experimentation and innovation contribute to system resilience. Following this model, a complex adaptive system (CAS) consists of an array of sub-systems, arranged in interrelated hierarchies, with each sub-system going through adaptive cycles a different rates (see Fig. 2). Hierarchies in this theory are not conceived as being a top-down structure of “authoritative control” [8 p. 392]. Instead, the subsystems in CAS are seen to have interlinked, but semi-autonomous—or loosely-coupled [13]—relationships.
Fig. 2: Adaptive Cycles in Hierarchies
Following this view, smaller sub-systems at lower levels in the hierarchy (e.g., local governance systems) go through cycles of change at a more rapid rate than do those that are larger and at a higher level (e.g., national governance systems). As they go through their adaptive cycles, these lower level sub-systems provide anticipative and innovative inputs to higher levels (e.g., information on emerging issues or results of policy interventions), while higher levels generally serve to “stabilize” [8 p. 393] conditions for lower levels (e.g.,
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supporting the implementation and further spread of policies that address local and broader system needs). As long as these exchanges are maintained, a degree of stability and continuity can be sustained in the system even as a “wide latitude for experimentation” increases the “speed of [system] evolution” [8 p. 393]. Seeing hierarchies as dynamic elements of a CAS offers a different metaphor for public administration. It suggests that i) top-down control in public organizations may not always be the appropriate focus, ii) resilient public administrations may be comprised of different sub-systems going through different phases in a learning (i.e., release and reorganization) and performance (i.e., exploitation and conservation) cycle, and iii) every sub-system may not need to be tightly connected, synchronized and aligned with the immediate priorities.
Resilience and the New Political Governance We now turn to an analysis of the New Political Governance (NPG) in the Canadian context with a view to providing some insights about it potential strengths and challenges with respect to resilience. To do this, we apply the key concepts derived from the Panarchy theory to the four distinguishing features of the NPG. The first of these features is that, in response to the pressures of governing in networked, information and media saturated societies, executive government engages in continuous electoral campaigning throughout their term in office. On the surface, there would appear to be potential in this behaviour for increasing resilience. If executive government authentically sought out, listened to, and learned from diverse sources at multiple levels in government and society, it might be able to tap the collective intelligence [4] and thereby improve its anticipative and adaptive capabilities. However, three practical problems immediately arise in realizing this potential for resilience via the NPG. The first is the problem of ‘short-termism.’ Any term in office is relatively short, but if they become synonymous with a campaign cycle then taking a long-term perspective becomes even more difficult. This suggests the ability to anticipate risks and issues over longer time horizons and to be proactive in the face of them is reduced under the NPG. The second problem is that elections and policy work are fought on partisan grounds, and have become more partisan over recent years [21]. If executive governing becomes synonymous with a campaign cycle, then this dogged partisanship (or dogmatism) may infect the overall approach to governing. This risks generating cognitive and other biases in both government and society, reducing anticipative capacities and limiting insights about what might ‘count’ as a ‘good’ ideas for change. For example, Aucoin [9] has observed how an increase in political pandering to core partisans in the Canadian electorate risks the creation of policies that do not reflect the interests of broader society. The third problem is that, under the NPG, executive government’s ‘normal’ cycle of work (based on a 4-5 year window) has accelerated to reflect the pace of a campaign cycle (of less than a year)—hence the use of ‘spin’ to describe what contemporary governments do [22]. This raises questions not only about substance, meaning and trust in governance, but also about the capacity of government to exercise a stabilizing influence in society. Before the NPG reforms, the problems of short-termism, political partisanship, and balanced, evidencebased policy were seen to have been mitigated by having in place a non-partisan public administration. The Westminster system of governance that forms the basis for Canadian parliamentary democracy has long been based on the idea of having a bureaucracy of skilled, non-partisan public servants able to ‘fearlessly’ provide impartial policy advice to the elected government of the day and to loyally implement decisions and programs [9]. These roles, in theory, provided a source of continuity, stability, and modulated change. Three key features of the NPG appear to be having a negative impact on these traditional functions of the public administration. The features include: i) an increase in the number of political staffers in executive government, creating a new set of powerful, partisan players at the interface between ministers and the public administration; ii) a politicization of appointments to the senior ranks of the public service, and iii) an increased emphasis on generating more responsiveness within the public administration to executive government [9]. They are creating a public administration that is both more responsive to political direction and more “promiscuously partisan” [9 p. 179] than in the past. Such changes may be undermining the public administration’s ability to function as a source of reliable data and information, evidence-based policy advice, and long-term thinking. Moreover, in its efforts to tightly align the internally control the public administration, the NPG may dampen the capacity for experimentation, agility and local decision-making. At least four speculative observations can be offered about resilience and the NPG. First, there seems to be significant risk for the NPG to contribute to rigidity traps as a result of its emphasis on centralization, tight alignment and internal control. Second, the NPG appears vulnerable to creating poverty traps because of the strength and depth of the partisan political ‘filtering’ it engenders, which may decrease the diversity and variety of anticipative insights and in adaptive options available at any time. If combined with fiscal austerity and the propagation of a climate of compliance or fear, the risks of creating each of these adaptive ‘traps’ may increase. Third, the combined ‘disruptions’ of increased centralization, control and politicization may invoke a ‘regime
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change’ in the public administration as a sub-system. Because the outcomes of such dramatic changes are uncertain (i.e. adaptive, maladaptive or catastrophic), such a situation could destabilize the overall governance system and create new vulnerabilities in it. Finally, if, as a result of NPG reforms, the public administration were no longer able to realize its historic functions, even in renewed form, then it is not clear where the stabilizing, anticipative and adaptive resources it once supplied would come from.
Conclusion Overall, our analysis and speculations suggest the contribution of the NPG to resilience in both public governance (and society) is open to question, particularly over the long haul. This finding suggests NPG reforms should be pursued with some degree of caution. However, the NPG explored in this paper represents an ‘ideal type’. The appearance of NPG-like governance in ‘reality’ will depend on, and vary with, “the [political] party in power, the prime minister, the state of competition between parties in the legislature and in the electorate, and, among other factors, the institutional and statutory constraints that provide checks against politicization” [9 p. 179]. Future research on the topic of resilience and the NPG would benefit from a comparative approach that documents actual governance practices in various Westminster systems. It important to note that the anticipative and adaptive capacities allowing for resilience in CAS (e.g., a system of public governance) cannot be ‘commissioned’ when needed; they must be nurtured continually [4][14]. Their foundations reside in: the capacity for learning, creative problem-solving and innovation in families, communities, organizations, institutions, networks [16][23]; trust among actors and in public institutions, supported by trustworthy information flows [24]; and, diversity in actors, sources of knowledge and ideas [25] institutional forms and governance arrangements [26], including co-management and shared governance [15][27]. As a precautionary measure, those implementing the NPG reforms (or those studying their implementation) may wish to monitor these foundations.
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Comfort, L. K. (1994). Risk and Resilience: Inter-organizational Learning Following the Northridge Earthquake of 17 January 1994. Journal of Contingencies and Crisis Management, 2(3), pp. 157-170. Walker, B., Holling, C. S., Carpenter, S. R., and Kinzig, A. (2004). Resilience, Adaptability and Transformability in Social–ecological Systems. Ecology and Society, 9(2). Retrieved from: http://www.ecologyandsociety.org/vol9/iss2/art5/ Scheffer, M., and Carpenter, S. R. (2003). Catastrophic Regime Shifts in Ecosystems: Linking Theory to Observation. Trends in Ecology and Evolution, 18(12), pp. 648–656. Carpenter, S. R., & Brock, W. A. (2008). Adaptive Capacity and Traps. Ecology and Society, 13(2). Retrieved from: http://www.ecologyandsociety.org/vol13/iss2/art40/ Adger, W. N. (2006). Vulnerability. Global Environmental Change, 16(3), pp. 268-281. Flynn, G. (2011). Rethinking Policy Capacity in Canada: The Role of Parties and Election Platforms in Government Policy-making. Canadian Public Administration, 54(2), pp. 235-253. Roberts, R. S. (2005). Spin Control and Freedom of Information: Lessons for the United Kingdom from Canada. Public Administration, 83(1), pp. 1-23. Allenby, B. and Fink, J. (2005). Toward Inherently Secure and Resilient Societies. Science, (Aug 12)309, pp. 1034-1036. Longstaff, P. H., & Yang, S. (2008). Communication Management and Trust: Their Role in Building Resilience to "Surprises" Such as Natural Disasters, Pandemic Flu, and Terrorism. Ecology and Society, 13(1). Retrieved from http://www.ecologyandsociety.org/vol13/iss1/art3/ Berkes, F. & Folke, C. (2002). Back to the Future: Ecosystem Dynamics and Local Knowledge. In L. H. Gunderson and C. S. Holling (Eds.), Panarchy: Understanding Transformations in Human and Natural Systems. [pp. 121-146]. Washington: Island Press. Baker, D. & Refsgaard, K. (2007). Institutional Development and Scale Matching in Disaster Response Management. Ecological Economics, 63(1-2), pp. 331-343. Cash, D. W., Adger, W., Berkes, F., Garden, P., Lebel, L., Olsson, P., Pritchard, L., & Young, O., (2006). Scale and Cross-scale Dynamics: Governance and Information in a Multilevel World. Ecology and Society, 11(2). Retrieved from: http://www.ecologyandsociety.org/vol11/iss2/art8/
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Organizational resilience and commitment to workplace Pavalache-Ilie M.1, Rioux L.2 1
Université Transilvania de Brasov (ROMANIA) Université Paris Ouest La Defence (FRANCE)
[email protected], lrioux@u/paris10.fr 2
Abstract The organisation confronting economic and social challenges linked to globalisation or more concrete events is not resilient, is not resistant as such but it can create favourable conditions supporting the development of its resilience, which contribute to a better adhesion of employers and their management. Our research is focus on the link between organisation’s capacity to deal with its difficulties and attachment of its employees, teachers and administrative staff to their university. Results support the existence of a link between resilient behaviour and attachment of working place. More precisely, we demonstrate that « Flexibility » and « Proactive solutions » dimensions from the inventory of resilient behaviours present significant correlations with attachment to working place. Key words: resilience behaviour, attachment of working place, university, Romania
Cadrage théorique Le concept de résilience est au centre de nombreux travaux actuels, dans des disciplines très diverses telles que la physique, l’informatique, l’écologie ou la psychologie [1]. Du niveau ponctuel et très concret de la mécanique, la résilience s’est enrichie en significations. Elle s’est affirmée en 2005 lors la Conférence de Hyogo comme une priorité nationale pour plusieurs pays tels que les Etats Unis, l’Australie et le Canada [2]. Dans le cadre organisationnel, Vanistendael et Lecomte (2000) la définissent comme la capacité d'une personne, d'un groupe ou d’une organisation à se projeter dans l'avenir en dépit d'événements déstabilisants, de conditions de vie difficile, de traumatismes parfois sévères. Autrement dit, qu’elle soit confrontée aux turbulences économiques et sociales liées à la mondialisation ou à des événements plus ponctuels, l’organisation n’est pas résiliente en tant que telle, mais peut créer des conditions favorables au développement de sa résilience, ce qui contribue à une meilleure adhésion des employés à sa gouvernance. Le risque fut une de premières situations menaçantes quand la problématique de la résilience organisationnelle fut abordée, pour devenir ensuite intéressante par rapport avec la performance, dans un champ plus large du management des organisations centrées sur l’efficience économique. Hollnagel, Journé et Laroche [4] souligne que «la résilience ne se produit pas instantanément, qu’elle n’est pas de l’ordre du réflexe organisationnel ou de l’injonction managériale mais qu’elle possède une épaisseur temporelle, sans doute nécessaire à son élaboration». Les crises qui suivent une turbulence de l’environnement peuvent renforcer la résilience de l’organisation par deux processus complémentaires liés : «un apprentissage de renforcement positif au niveau de l’absorption du choc et un apprentissage double boucle incluant des changements stratégiques permettant de réduire la vulnérabilité de l’organisation» [5]. L’attachement au lieu est un concept central en psychologie environnementale qui renvoie aux liens que les personnes entretiennent avec les lieux qui leur sont chers [6]. Même si des divergences conceptuelles et méthodologiques ont traversé ce courant, la majorité des chercheurs présente l’attachement au lieu comme un lien émotionnel [7]. Plus précisément, s'appuyant à la fois sur la théorie de l’attachement de Bowlby (1980) et celle de l'attachement au lieu élaborée par Schumaker et Taylor (1983), ils le définissent comme la composante affective du lien qui unit une personne avec un lieu donné [10]. Si les liens entre résilience et attachement sont relativement bien cernés dans le cadre de la psychologie développementale, en revanche, ils sont peu explorés dans le cadre organisationnel.
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Objectifs Notre recherche porte sur le lien existant entre la capacité des membres de l’organisation à surmonter les difficultés au travail et l’attachement des employés envers leur organisation. Le premier objectif vise à valider une variante roumaine de l’inventaire des comportements résilients au travail. Le deuxième objectif se propose d’identifier les relations qui existent entre la résilience des membres de l’organisation universitaire et leur attachement au lieu de travail.
Methodology 1.1
Echantillon et procédure
Notre population est composée de 72 personnes (35 enseignants et 37 personnel administratif) d’une université roumaine, âgés de 20 à 66 ans. Le personnel administratif est exclusivement composé de femmes. Les enseignants (16 femmes et 19 hommes) sont assistants (5), lecteurs (10), maitres de conférences (3) et professeurs (17). La participation s’est faite sur la base du volontariat, pendant les heures de travail.
1.2
Matériel
Les données ont été collectées à l’aide d’un outil en trois parties : une partie signalétique permettant de repérer certaines variables sociodémographiques (âge, sexe, catégorie de personnel, degré didactique) ; l’adaptation roumaine de l’inventaire des comportements résilients au travail [11] et l’échelle d’attachement au lieu de travail - EALT [12]. Les réponses se donnent sur des échelles en cinq points allant de 1 (pas du tout d’accord) à 5 (tout à fait d’accord).
Resultats 1.1 1.1.1
Les analyses factorielles L’échelle de résilience
Une première analyse en composantes principales a été menée en intégrant tous les items de l’inventaire des comportements résilients au travail. Elle fait apparaitre 6 facteurs dont la valeur propre est supérieure à 1. Cependant deux d’entre eux ne comprennent que deux items et ont été supprimés. Par ailleurs, l’item a été enlevé car il diminuait l’alpha de Cronbach de 0,12. Une seconde analyse en composantes principales a alors été conduite avec les 15 items restants. Les résultats sont regroupés dans le tableau 1.
Tableau 1. Analyse en composantes principales avec les 15 items de l’échelle de résilience
4. J’ai essayé de trouver des solutions alternatives à un problème. 8. J'ai cherché des solutions à un problème avec mes collègues. 3. J'ai échangé avec mes collègues sur des améliorations possibles. 9. J’ai travaillé pour progresser dans mon travail. 2. J’ai été capable de remplacer temporairement un collègue. 13. Je suis arrivé(e) à un bon résultat en improvisant. 6. J'ai pris des décisions, même si je n’étais pas sûr(e) à 100 %. 7. Je me suis débrouillé(e) pour éviter certaines tâches parce que je me sentais débordé(e). 19. Je n'ai pas pu exécuter des tâches selon la procédure, parce que je n’avais pas les ressources nécessaires.
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M
ET
F1
F2
F3
F4
4,47
0,80
0,77
0,15
0,10
0,13
4,40
0,96
0,74
0,21
0,10
0,16
4,25
1,10
0,68
0,04
0,19
0,20
4,54
0,67
0,67
-0,03
-0,25
0,10
3,90
1,41
0,56
-0,03
0,30
-0,04
2,85
1,24
-0,08
0,79
0,22
0,20
3,53
1,35
0,27
0,73
0,04
-0,11
2,19
1,25
0,06
0,62
-0,07
-0,23
2,57
1,38
0,02
0,00
0,77
0,20
The Second World Congress on Resilience: From Person to Society (Timisoara - Romania, 8-10 May 2014)
20. J’ai manqué d’informations pour faire face à une situation difficile. 14. J’ai été sceptique face à une situation nouvelle. 16. J’ai adapté ma manière de travailler à la situation. 11. J’ai évité tout risque. 5. J’ai considéré un problème comme un défi. 18. Je me suis arrangé pour éviter une situation qui me semblait chaotique. Valeur propre % variance expliquée Alpha de Cronbach
2,96
1,11
0,24
0,07
0,74
-0,22
2,86 4,33 3,38 3,49
1,23 0,92 1,20 1,37
0,07 0,13 0,22
0,06 -0,07 -0,25 1,37
0,61 0,14 -0,08 -0,15
0,15 0,69 0,65 0,62
3,33
1,47
1,35
0,35
0,59
1,86 0,12 .60
1,95 0,13 .63
1,93 0,13 .58
2,63 0,18 .75
Une structure expliquant 56% de la variance émerge. Elle comprend quatre facteurs : F1 « Solutions proactives » (5 items), F2 « Improvisation » (3 items), F3 « Disponibilité des ressources » (3 items) et F4 « Adaptabilité/flexibilité » (4 items). Notons que l’alpha de Cronbach calculé à partir des items composant le facteur 4 parait un peu faible (0,58). Cinq items recueillent des moyennes supérieures à 4,00, dont quatre composant le facteur « Solutions proactives ».
1.1.2 L’échelle d’attachement au lieu de travail Le Tableau 2 présente les moyennes et les écarts-types et la structure factorielle de l’échelle d’attachement au lieu de travail. Tableau 2 La structure de l’échelle d’attachement au lieu de travail
1. Je suis attaché(e) à mon lieu de travail. 2. Il me serait très difficile de quitter définitivement mon lieu de travail. 5. Ce lieu de travail fait partie de moi-même. 6. Il y a des lieux dans l'université qui me rappellent des souvenirs. 4. Si mon université devait déménager, je regretterais mon lieu de travail actuel. 7. Après un congé, je suis content(e) de retrouver mon lieu de travail. 3. Il y a des endroits dans l'université auxquels je suis tout particulièrement attaché(e) Attachement total Valeur propre % variance expliquée
M 4,43 4,24
ET ,80 ,90
Score factoriel 0,82
4,14 4,08
1,05 1,09
0,81
4,04
1,14
3,94
1,16
3,58
1,31
4,07
,80
0,62 0,81 0,71 0,70 0,75 3,92 56%
Nous retrouvons la structure unidimensionnelle postulée par Rioux (2006). La valeur propre est de 3,92 et le pourcentage de variance expliquée de 56%. L’alpha de Cronbach est tout à fait satisfaisant (0,88). Les moyennes des items varient de 4,43 pour l’item «Je suis attaché(e) à mon lieu de travail » à 3,58 pour l’item «Il y a des endroits dans l’université auxquels je suis tout particulièrement attaché(e) ». Les écartstypes sont modérés (de 0,80 à 1,31).
1.2
Les liens entre la résilience au travail et les variables sociodémographiques et organisationnelles
Parmi les variables sociodémographiques cernées (genre, âge, études), seule l’âge corrèle avec la résilience au travail. Plus précisément, cette variable présente une corrélation significative à .05 avec le facteur 4 « Adaptabilité/flexibilité » (r=.32). Les variables organisationnelles (type de personnel, ancienneté) n’ont aucun lien significatif avec les facteurs de la résilience. En revanche, des analyses de variance effectuées en prenant comme facteur le statut des enseignants (professeur, maître de conférences, lecteur, assistant) et comme variables dépendantes les scores moyens obtenus aux facteurs de la résilience, indiquent une différence significative entre le statut et le facteur «
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Solutions proactives » (F3=6,05, p
