The majority of refugees do not develop stress-related disorders from any cause.1 The capacity for a positive adaptive response is the product of the total resources that refugees have at the onset of their journey and the extent of resources that they are able to foster and protect through the period of resettlement. While it is important to understand and address mental health problems of refugees, it is also respectful to honor their capacity for resilience and to foster positive adaptation by helping them obtain and protect internal and environmental resources.
“I have crossed so many rivers, I no longer get wet” is a Kurdish saying that identifies the prolonged exposure to traumatic experiences and the resistance or resilience of refugees. Resistance is a term that has been used to describe that majority of persons who experience transient but not enduring psychological distress after severe stressful experiences.2 Resilience is the ability to maintain relatively stable, healthy levels of psychological functioning in the face of highly threatening events.3 Resilience is often thought of as a process, and has been shown to be predicted by higher cognitive ability, positive self-esteem, hopefulness, problem solving repertoire, and flexibility.4
Refugees have been shown to have a remarkable degree of both resistance and resilience to mental health difficulties. They often talk about how potential losses (e.g., to agency or physical well-being) had either been averted or how actual losses (e.g., vitality, freedom) had been regained or recreated over time. Refugees say that it was the interaction between who they are and what they have, who and what they have lost, and who and what they have regained that either helped them survive and thrive or caused further pain and suffering. As part of the New Mexico Refugee Project, factors of resilience were evaluated in Kurdish and Vietnamese refugees. Internal resilience and external protective factors were re-conceptualized to illustrate distinctions between innate characteristics, resilient actions, and protective factors associated with context. Categories of innate characteristics included: strength, adaptability, belonging, and purpose. Categories of resilient actions paralleled innate characteristics (i.e., actions of strength, actions of adaptability, etc.). Protective factors associated with context included: personal resources, social networks, place, social institutions, community stability, and relationship with social institutions. Hobfoll and colleagues have built on theoretical work by outlining four symptom trajectories over time during an ongoing threat of mass casualty, in this case the latter period of the Second Intifada.5 The symptom trajectory categories were resistant, resilient, chronic distress, and delayed distress. The primary factor that was associated with resistance or resilience and thus good psychological adaptation was less resource loss.
Refugees as a group tend to be resistant and resilient to psychiatric disorders, perhaps owing to their adaptation over time to multiple stressful situations. Promoting resilience by helping the refugee retain current resources and re-gain those important lost resources is a critical function of the resettlement agency and health-care personnel in the early weeks and months after arriving in the host country.
References
1. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005; 365(9467): 1309-14.
2. Bonanno GA, Galea S, Bucciarelli A, Vlahov D. Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Psychol Sci. 2006; 17(3): 181-6.
3. Bonanno GA. Clarifying and extending the construct of adult resilience. American Psychologist. 2005; 60: 265-667.
4. Richardson GE. The metatheory of resilience and resiliency. J Clin Psychol. 2002; 58(3): 307-21.
5. Hobfoll SE, Palmieri PA, Johnson RJ, Canetti-Nisim D, Hall BJ, Galea S. Trajectories of resilience, resistance, and distress during ongoing terrorism: the case of Jews and Arabs in Israel. J Consult Clin Psychol. 2009; 77(1): 138-48.