Uncertain Legacies: Resilience and Institutional Child Abuse - A Literature Review

4 Defining Resilience

Introduction

4.1 This chapter describes the way in which the concept of resilience has developed in recent years and, in the absence of a single, firm definition, suggests some key characteristics associated with resilience.

Background

4.2 In common with many other forms of abuse, the scale and scope of child abuse is unknown (Davidson et al, 2010). Collishaw et al (2007) conducted a longitudinal survey of a general population sample in the Isle of Wight to evaluate rates of psychiatric disorder, social and family functioning, and childhood maltreatment. The original Isle of Wight study was an epidemiological investigation in child psychiatry initiated in 1968 which, in its first wave, involved 571 adolescents and their parents, and the majority of participants were subsequently revisited in mid-life, generating comparative data between adolescence and adulthood. Ten percent of participants reported experiencing abuse as children, and by retrospectively comparing the data of abused and non abused participants in this particular study, Collishaw and colleagues demonstrate a potential link between childhood abuse and elevated risk of compromised mental ill health in adulthood.

4.3 The literature reviewed illustrates the well-documented outcomes and impacts many children suffer as a consequence of their abuse. These include physical and psychological problems which can impact in the longer term such as mental health issues, including Post Traumatic Stress Disorder (PTSD) and depression, gynaecological problems, loss of religious or spiritual faith, and emotional disturbances (for example, Davidson et al, 2010; Wolfe et al, 2003; Collishaw et al, 2007; Hall, 2003). As a consequence, the impacts of the experience of abuse as a child can be longstanding, and lead to difficulties in forming intimate and caring relationships; substance and alcohol abuse; suicidal thoughts or attempts; criminal offending; and problems finding and maintaining employment, which lead to higher risks of poverty and homelessness (Wolfe et al, 2003; Lev-Weisel, 2008; Jackson and Martin, 1998; Roman et al, 2008). While some of these impacts may be alternatively perceived as short term coping strategies - for example, drug or alcohol use may be mild, temporary and ameliorative in nature, rather than inevitably damaging (Flanagan-Howard et al, 2009 et al; O'Leary, 2009) - there is little doubt in the literature that those exposed to abuse as a child remain at enduring risk of compromised physical and mental health, impaired social functioning and constrained economic circumstances long after the abuse has ceased and the child has reached adulthood.

4.4 Many adult survivors describe ongoing struggles to come to terms with the harm inflicted on them as children, but researchers have also observed significant proportions of adult survivors of abuse who report few or no such persisting problems (Collishaw et al, 2007; Daniel, 2010). Of the papers reviewed for this report, the proportion of such participants ranged from 13% in one study to as high as one third in another (Hauser, 1999; Simpson, 2010; Werner, 1992). That substantial numbers of survivors have gone on to live lives which are happy and stable despite suffering severe trauma was seen as surprising. Some authors drew attention to the unexpectedness of resilient responses. These are described as, for example, "better-than-expected outcomes" (Hauser and Allen, 2006, p551), and refer to participants achieving in their lives in ways which "far surpassed what their backgrounds would predict" (Thomas and Hall, 2008, p162).

4.5 A research focus which has prioritised - understandably - an exploration of the difficulties and needs of those who continue to suffer negative impacts into adulthood means that "We currently know more about posttraumatic problems than strengths" (Hall, 2003, p648). In recent years, attention has been drawn to these diverse narratives of survival, and prompted interest in what might explain differential experiences. The concept of resilience is increasingly seen as helpful in understanding why survival experiences might vary from individual to individual.

What is resilience?

4.6 Before assessing the utility of the concept of resilience in understanding the experiences of adult survivors of ICA, it is important to establish what is meant by 'resilience'. The papers used in this review reflected two decades of conceptual development, during which time resilience has been variously perceived to be an individual personality trait, an outcome or state of being, and a process (Roman et al, 2008). Over this period, theoretical work has increasingly focussed on resilience as a process, drawing on empirical studies such as the work of Werner and colleagues who conducted a longitudinal, developmental study of almost 700 babies born on the island of Kauai in 1955, and monitored them regularly for the first thirty years of their lives. The study set out to examine the impact on human development of a variety of life adversities on individuals, examining their exposure to a range of different risks, and what helped them recover when risk translated into harm. The Kauai study categorised one third of the participants as 'resilient', observing that despite their 'high risk' status as children, by young adulthood they "loved well, worked well, played well, and expected well." (Werner, 1992, p263). Moreover it "…identified…protective buffers and mechanisms that operated in the lives of vulnerable youths who succeeded 'against the odds'" (ibid, p265). Although originally conducted half a century ago, and within a particular cultural context, this work is cited regularly in the literature used in this review, and the research trajectory over the last two decades has shown a move away from identifying resilience as an inherent identity trait which individuals either possess or lack, towards understanding it as a complex, conditional, interactive response process between adverse experiences and coping strategies. Roman et al (2008), for example, describe a longitudinal process of "becoming resolute" (p187), whereby individuals were not unscathed by their abuse experiences but nevertheless reported a sense of contentment, stability and success in aspects of their adult lives which sustained them through times during which they struggled. As a result, difficult periods could be navigated without denying or dwelling upon the past. Thomas and Hall's paper supports this, drawing on triple in depth interviews conducted with 44 women over a 9 month period, and reporting that participants were not necessarily free of psychological difficulties yet were able to thrive (2008). What was noted was a marked "resolute determination" (p162), a commitment to persevere and work hard to overcome the impacts of abuse, and to move beyond those experiences.

4.7 Twenty one of the papers reviewed offered definitions of resilience, some original, some drawing on the work of others to produce a composite definition. Many of these referred to an absence of significant psychological ill-health (Collishaw et al, 2007; Simpson, 2010), but moreover described a process of positive adaptation in spite of difficulties: "successful developmental adaptation despite serious risk and adversity" (Hauser, 1999, p2); "favourable development in unfavourable circumstances" (Gilligan, 2008, p37); "successful adaptation in spite of experiencing a high-risk trauma" (Simpson, 2010, p241); and "positive adaptation to significant risk" (Dearden, 2004, p187). However, Houston (2010) refers simply to "normal development under difficult conditions" (p358), reinforcing Liepold and Staudinger's (2006) argument that resilience is simply the persistence of a "'normal' (or stable or successful) developmental course under potentially endangering circumstances" (in Leipold and Greve, 2009, p44). Nevertheless, it can be seen that the various definitions proposed in the literature reviewed broadly converge in substance: two elements were apparent in all definitions: they described positive personal responses in the face of adverse external events. For example, resilient individuals displayed "positive adaptation" (Dearden, 2004, P187) and "persistence" (Laursen and Birmingham, 2003, P242), made "affirmative changes" (Hall, 2003, p663), and were "functioning exceptionally well" (Hauser, 1999, p11). These positive reactions were in response to, and in spite of, potentially damaging events and traumatic experiences.

4.8 However, despite extensive research and developmental work, it has proved impossible to establish a single, comprehensive, universally accepted definition that captures 'resilience' (Smith-Osborne, 2007; Daniel, 2010). Nevertheless, although the literature reviewed here proposed a variety of definitions, it overwhelmingly identifies resilience as a process and, despite a lack of a single overarching definition there are a range of interlinking characteristics which might be associated with resilience: while the concept remains persistently nebulous, we can describe what it looks like. In so doing, some of the difficulties of providing a concrete definition become apparent:

• Dynamic: If resilience is neither a static personality trait nor a discrete outcome but rather a process, this in itself suggests an element of dynamism. Simply expressed, resilience is demonstrated when an external stimulus appears to prompt a positive personal reaction in an individual. However, although resilience might be exhibited in the presence of external provocation, whether it exists as a response to, or in spite of, adversity is unknown. It would be wrong to conceive resilience, therefore, as a simple and consistent stimulus/response pattern intrinsic to particular individuals, and absent in others. Rather, engagement and effort is involved: this might include actively resisting particular life choices; making changes in one's life; and trying to understand events and the actions of others, for example (Bender et al, 1996; Hall, 2003; Hauser, 1999). Many authors choose words which imply change, growth, movement and vitality to describe positive responses when faced with challenges and trauma: individuals might learn, adjust, adapt, and as a consequence, develop (Bender et al, 1996; Colton et al, 2002; Gilligan, 2008; Hall, 2003; Laursen and Birmingham, 2003; Roman et al, 2008). It would seem that through the enactment of positive responses, individuals themselves are altered: the process is transformative. Resilience is not merely a state of being, nor is it simply reflexive, an inherent response to a negative experience or event: it is "an evolutionary process" (Thomas and Hall, 2008, p153).
• Contingent: As it is dynamic and highly individualised in nature, resilience is dependent on a range of factors which shape personal responses. In the first instance, resilience is demonstrated in someone's reaction to negative stimulus which acts as a catalyst, provoking response. Resilience is therefore dependent on exposure to potential dangers or challenges, which the literature broadly describes collectively as 'risks': that is, adverse events and experiences that may increase the chance of poor outcomes. Encountering risks in life may not necessarily be damaging: Rutter argues that repeated encounters with mildly stressful situations might help to incrementally strengthen an individual's ability to respond resiliently (in Daniel et al, 1999; Daniel, 2010). However, exposure to similar risks prompts diverse reactions among individuals; thus those who have been subjected to childhood abuse in similar circumstances by the same perpetrator may recount vastly different narratives of survival, some negative, some positive (Lev-Weisel, 2008). The diversity of responses to similar risk suggests that resilience might either be facilitated or constrained by a range of other context-specific factors, affecting unique individuals in particular circumstances.
• Longitudinal: This evolutionary process is inevitably conducted throughout a lifetime: resilience is not a permanent feature of particular individuals, and might be unpredictable and inconsistent within them: it ebbs and flows in response to different sets of circumstances throughout life, but can also be nurtured and strengthened at any age (Daniel et al, 1999; Daniel, 2010; Thomas and Hall, 2008).
• Multidimensional: Not only does resilience fluctuate across time, it also varies across different areas of an individual's life. Stress, adverse events and challenges might be experienced across multiple domains of life, and an individual may respond resiliently in one area, while struggling to cope in another (Gilligan, 2008; Perkins and Jones, 2004). Resilience is not fixed in personality, nor is it anchored within specific personal domains.
• Highly individualized - yet dependent on others: The characteristics described above help to explain why a formal and comprehensive definition of resilience is hard to achieve. This final characteristic further compounds that difficulty: "Development and resilience are rooted in human relationships and interactions." (Daniel et al, 1999, p14). Factors that affect resilience will be discussed in the next section, but it is clear from the headings - internal/personal, external/social, and structural - that understanding the impacts of traumatic experiences, and individual responses to them, must be grounded in distinct personal and social environments that alter over time. Daniel suggested that resilience is: "the ability to know where, how and when to put your energies to improve things for yourself and how to recruit help in that endeavour." (2008, p61). This implies knowledge, availability, and accessibility to social resources, yet we know that tapping into such resources may be constrained for individuals for many reasons: another contingency in the development of resilience.

4.9 A single, comprehensive, widely accepted definition of resilience remains elusive and these qualities which delineate it help to explain why: they suggest a fluid, lifelong process that is context-specific, yet fluctuates both within and between individuals across multiple aspects of their lives, and is subjectively shaped by personal circumstances and social interactions. A simplistic perception of resilience as a dimension of personality overlooks the existence of these interlinking, overlapping characteristics that contribute to resilience (Liepold and Greve, 2009). Although the nebulousness of existing definitions may prove challenging for policy development, it does, however, allow a more sophisticated understanding of what appears to be a highly complex process. Werner's seminal study identified distinctive features that appeared to have a buffering effect, shielding the child against permanent, deeper damage than might be expected (Werner, 1992). The next chapter discusses factors which were identified in the literature as potentially protective and which combine and interact to influence the development of resilience in individuals.