Astier M. Almedom

Resilience is not the Absence of PTSD any More than Health is the Absence of Disease

Resilience may mean different things to different researchers and practitioners in psychology and public health: A process, an outcome, a dynamic steady state in the face of adversity, and defiance of risk/vulnerability are among the variety of understandings of the concept that are extant. This article summarizes the results of a systematic review of the literature on definitions and measurements of resilience. It is evident that resilience is more than the absence of “posttraumatic stress disorder,” just as health (and indeed mental health) is more than the absence of disease (or mental/behavioral disorder). A multidimensional construct, resilience a requires a multimethod and multilevel study design that combines both qualitative and quantitative techniques to be examined satisfactorily. Seven selected studies are discussed in detail, highlighting examples that offer a fuller understanding of resilience in its sociocultural and ecological context.

RESILIENCE, HARDINESS, SENSE OF COHERENCE, AND POSTTRAUMATIC GROWTH: ALL PATHS LEADING TO “LIGHT AT THE END OF THE TUNNEL”?

ABSTRACT Two questions prompted this targeted review: (a) What are the behavioral and social determinants of individual and/or collective resilience—the capacity to rebound from crisis? and (b) Is the evidence base for related concepts, including hardiness, sense of coherence, and posttraumatic growth consistent? The findings suggest that the theory of salutogenesis, operationalized by the sense of coherence construct, is inclusive of the related concepts of resilience and hardiness. Moreover, it is grounded in robust primary research of cross-cultural relevance. More recent concepts of recovery and posttraumatic growth also contribute to our understanding of resilience. Implications for international humanitarian psychosocial programming are discussed.

MENTAL WELL-BEING IN SETTINGS OF ‘COMPLEX EMERGENCY’: AN OVERVIEW

The mental state of people affected by war and other disasters has been a subject of special interest to academic researchers and practitioners in humanitarian assistance and public health for over two decades. The last decade in particular has seen a rise in the number of papers published in scholarly journals around the Post-Traumatic Stress Disorder (PTSD) debate. Anthropologists have rarely engaged in this debate. Nevertheless, some of the most illuminating contributions have come from socio-medical anthropology (Last, 2000). This volume brings together a wide range of disciplines in the human sciences to address some of the key questions that bear upon the mental health and well-being of populations affected by war and displacement, with contributions from applied biosocial and medical anthropology (Almedom; Lewando-Hundt et al.); applied psychology/public health and social psychiatry (Carballo et al.; Snider et al.; Fullilove et al.); social work (Ahearn & Noble); and political sciences (Pupavac). The four themes that run through this set of papers (outlined below) remain topical areas of contention in contemporary humanitarianism. Scholars and practitioners in the biosocial sciences may wish to engage in the empirical study of human (if not humanitarian) responses to disaster focusing on questions as yet unanswered.

Social Capital and Mental Health

Social capital is a compound and complex construct, an umbrella term under which social cohesion, social support, social integration and/or participation are often lumped together. Beyond its growing appeal to policy makers, practitioners and researchers in public health in general and mental health in particular, social capital is now also an integral part of broad-based discussions on social-ecological resilience, ecosystem sustainability, and the collective management of natural resources (see for instance, Adger et al., 2005; Hardin, 1968; Pretty, 2003). This chapter revisits and updates the analysis presented in an earlier interdisciplinary review of primary evidence linking social capital and mental health (Almedom, 2005).

Evaluating rapid participatory rural appraisal as an assessment of ethnoecological knowledge and local biodiversity patterns.

There is a pressing need to find both locally and globally relevant tools to measure and compare biodiversity patterns. Traditional ecological knowledge (TEK) is important to biodiversity monitoring, but has a contested role in preliminary biodiversity assessments. We examined rapid participatory rural appraisal (rPRA) (a tool commonly used for local needs assessments) as an alternative to surveys of vascular plants conducted by people with local knowledge. We used rPRA to determine the local-knowledge consensus on the average richness, diversity, and height of local grasses and trees in three habitats surrounding Boumba, Niger, bordering Park-W. We then conducted our own vascular plant surveys to collect information on plant richness, abundance, and structure. Using a qualitative ranking, we compared TEK-based assessments of diversity patterns with our survey-based assessments. The TEK-based assessments matched survey-based assessments on measures of height and density for grasses and trees and tree richness. The two assessments correlated poorly on herb richness and Simpsons D value for both trees and grasses. Plant life form and gender of the participant affected the way diversity patterns were described, which highlights the usefulness of TEK in explaining local realities and indicates limitations of using TEK as a large-scale assessment tool. Our results demonstrate that rPRA can serve to combine local-knowledge inquiry with scientific study at a cost lower than vascular plant surveys and demonstrates a useful blunt tool for preliminary biodiversity assessment.

Maternal psychosocial well-being in Eritrea: application of participatory methods and tools of investigation and analysis in complex emergency settings

OBJECTIVE To establish the context in which maternal psychosocial well-being is understood in war-affected settings in Eritrea. METHOD Pretested and validated participatory methods and tools of investigation and analysis were employed to allow participants to engage in processes of qualitative data collection, on-site analysis, and interpretation. FINDINGS Maternal psychosocial well-being in Eritrea is maintained primarily by traditional systems of social support that are mostly outside the domain of statutory primary care. Traditional birth attendants provide a vital link between the two. Formal training and regular supplies of sterile delivery kits appear to be worthwhile options for health policy and practice in the face of the post-conflict challenges of ruined infrastructure and an overstretched and/or ill-mannered workforce in the maternity health service. CONCLUSION Methodological advances in health research and the dearth of data on maternal psychosocial well-being in complex emergency settings call for scholars and practitioners to collaborate in creative searches for sound evidence on which to base maternity, mental health and social care policy and practice. Participatory methods facilitate the meaningful engagement of key stakeholders and enhance data quality, reliability and usability.

Morinda Revisited: Changes in Nutritional Well-being and Gender Differences After 30 Years of Rapid Economic Growth in Rural Punjab India

A follow-up study of malnutrition and its determinants among children 6 to 24 months of age was carried out in rural areas of Punjab State in India 30 years after the original study, and following a period of rapid economic growth. The original 1971 study had found a high prevalence of mortality and malnutrition and the worst gender difference in nutritional status ever recorded in an Indian study. The 2001 follow-up study found dramatic reductions in child mortality, child malnutrition, gender-based imbalances in child well-being and care, and family size, the result of participatory economic growth coupled with broad-based educational, health, and family-planning services. Despite overall improvements in caloric intake, however, 40% of lower-class children in 2001 were still consuming less than 50% of their caloric allowance. With minimal gender-based abortion and significantly reduced neglect and mortality of female children, gender balance among children in this area of rural Punjab improved markedly over the 30-year period.

Influence of forest management systems on natural resource use and provision of ecosystem services in Tanzania

Social, religious and economic facets of rural livelihoods in Sub-Saharan Africa are heavily dependent on natural resources, but improper resource management, drought, and social instability frequently lead to their unsustainable exploitation. In rural Tanzania, natural resources are often governed locally by informal systems of traditional resource management (TRM), defined as cultural practices developed within the context of social and religious institutions over hundreds of years. However, following independence from colonial rule, centralized governments began to exercise jurisdictional control over natural resources. Following decades of mismanagement that resulted in lost ecosystem services, communities demanded change. To improve resource protection and participation in management among stakeholders, the Tanzanian government began to decentralize management programs in the early 2000s. We investigated these two differing management approaches (traditional and decentralized government) in Sonjo communities, to examine local perceptions of resource governance, management influences on forest use, and their consequences for forest and water resources. While 97% of households understood the regulations governing traditionally-managed forests, this was true for only 39% of households for government-managed forests, leading to differences in forest use. Traditional management practices resulted in improved forest condition and surface water quality. This research provides an essential case study demonstrating the importance of TRM in shaping decision frameworks for natural resource planning and management.