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

5 Factors Affecting Resilience

Introduction

5.1 This chapter outlines the various factors associated with resilience. Although the chapter is divided into three sections - internal/personal, external/social, and structural factors - the literature emphasises that varying elements from each of these domains intertwine to produce what is perceived to be resilience in individuals.

5.2 Werner's original research in Kauai identified a range of factors relating to personal characteristics, interpersonal relationships and environmental circumstances which seemed to affect the development of resilience across the lifespan of the individuals who took part in the study (1992). The literature which has emerged since that study provides an extensive list of factors which might be associated with resilience, and these are often categorised as 'risk' or 'protective' factors. Daniel defined risk as "the chances of adversity translating into actual negative outcomes" (2010, p233), while protective factors are resources, both personal and social, which may moderate the negative impacts of harm for individuals (Hauser, 1999). These include supportive, secure relationships with family and friends, and connections to wider social and community networks (Daniel, 2008; Werner, 1992; Laursen and Birmingham, 2003). Many risk factors are seen to be immutable - for example, living in a dysfunctional family - but are also only indicative of the potential for harm rather than a guarantee - those who experience abuse in childhood are at higher risk of developing post-traumatic stress disorder, for example, but not all survivors go on to do so. There has been a shift of emphasis, therefore, from a research focus on risk factors to the protective factors which seem to offset potentially negative outcomes and encourage resilience (Dearden, 2004).

5.3 However, just as the presence of risk factors does not inevitably translate into harm nor does access to protective factors automatically result in resilience. Instead, the balance between risk and protective factors mediates responses in any particular situation (Simpson, 2010). Laursen and Birmingham (2003) described this as a "dynamic tug of war" (p240) among a diverse array of personal, social and structural elements which help to shape an individual's response to traumatic events and experiences (Bogar and Hulse-Killacky, 2006; Collishaw et al, 2007; Hauser, 1999; Laursen and Birmingham, 2003; Simpson, 2010). Masten, cited in Hauser (1999), points to two criteria which indicate resilience: an internal sense of well-being; and effective environmental functioning (p4). The relationship between the internal and external is therefore crucial to understanding how individuals respond to harmful experiences.

5.4 The interactive nature of a range of internal and external elements demonstrated in the literature suggests it is impossible to single out any one factor, or group of factors, which makes an individual more or less likely to demonstrate resilience. Furthermore, the presence of specific protective factors does not indicate resilience; the literature suggests a looser association rather than a direct correlation (Bender et al, 1996). That is, the presence of any of these elements in someone's life may help to increase their ability successfully to process harm done, but does not act as a concrete safeguard. Instead it is useful to see resilience as being generated by conditional interactions between intrinsic characteristics and individual circumstances (internal/personal), and interpersonal relationships and exchanges (external/social), which take place within broader social, economic and political frameworks (structural). None of these individual elements remain fixed over time; they can and do fluctuate and, crucially, might be compromised or reinforced (Gilligan, 2008; Dearden, 2004). This chapter organises the factors referred to in the literature under these three headings, and argues they can be seen as individual threads which, when combined, produce unique patterns of human response to adversities.

Internal/personal

5.5 This first category relates to factors which are associated with the individual. These include aspects of personality, perceptions of oneself and of the world, and they form four broad categories: self image; control; meaningfulness; and hope.

5.6 Self Image: A positive self image was seen by the majority of papers as vitally important to the development and maintenance of resilience. Self esteem and self efficacy were the most commonly cited personality traits in the literature (Daniel, 2008; Hauser, 1999; Heller et al, 1999; Houston, 2010; Laursen and Birmingham, 2003; Lev-Wiesel, 2008; Lösel and Bliesener, 1990; Werner, 1992). Having high self esteem, an ability to value and appreciate one's own worth, seems important in offsetting the negative impacts of external threats. Self efficacy, that is the confidence that one can act effectively, can be seen to underpin the process of recovery from trauma, as it reinforces the belief that healing is achievable. What seems to be important is not just a secure sense of self worth, but having confidence that one can capably negotiate life's challenges. These may be mutually reinforcing: individuals with a positive self-image see themselves as capable of overcoming hurdles, which generates determination and persistence, and consequently increases the likelihood that they will succeed, further enhancing self confidence and esteem (Hall, 2003; Hauser, 1999). Hall's secondary analysis of open-ended interviews with 55 women survivors of abusive childhoods reported that they were able to put themselves at the centre of their lives, prioritising their own needs, and were also able to harness momentum from positive life events and experiences in order to maintain self-focus (2003). Not only did they express a sense of control over their own destinies, but also over their environments (ibid). This resonates with other authors, who outline the various forms of control which are associated with resilience.

5.7 Control: The literature stressed the importance of an individual's perception of control, and of where and with whom power lies. The ability to exercise agency - to act independently of others, to make autonomous decisions, and therefore to feel in control of one's life - is associated with resilience (Gilligan, 2008; Hauser, 1999; Heller et al, 1999, Laursen and Birmingham, 2003; Lev-Wiesel, 2008). Self determination is therefore central (Gilligan, 2008), but many of the definitions of resilience also referred to adaptability, and it is important not only that individuals can make independent choices about their lives, but also that they can react effectively should unexpected events dictate a change of direction (Bogar and Hulse-Killacky, 2006; Liepold and Greve, 2009), reflecting the unavoidable interactions between individual and environment which sometimes result in negative experiences. Bogar and Hulse-Killacky's participants, 10 women who self-identified as resilient following childhood experiences of sexual abuse, described confidence in the temporary nature of events and emotions, and drew comfort from the impermanence of negative feelings they experienced as a consequence of further challenging life events (2006). When discussing resilience in relation to survivors of abuse, the literature draws attention to the importance of the ability to externally attribute blame for the abuse as characteristic of resilience (Bogar and Hulse-Killacky, 2006; Heller et al, 1999; Lev-Wiesel, 2008). Projecting responsibility onto the abuser contributed to an externalisation of anger and hatred, rather than absorbing it inwards (Lev-Wiesel, 2008). Simpson (2010) found surprisingly high levels of resilience among her participants, 134 women who had all been sexually abused as children and who completed a web based survey questionnaire, and partially attributed this to the fact that her study involved women who had publicly acknowledged their abuse; that is, they had disclosed their experiences to an external individual or agency. This was consistent with Bogar and Hulse-Killacky's study (2006), which similarly identified disclosure of abuse as a key factor, enabling participants to access support both formally through therapy or more informally with others, and to reach acceptance. Being actively engaged in, and controlling, the process of recovery and healing can be seen as a desire to care for oneself, and this might be linked to self esteem. An ability to self protect may also therefore be associated with resilience. Hall (2003) describes this as "interpersonal insulation" (p657): the ability to identify and avoid potentially dangerous people, and to build healthy supportive social networks instead.

5.8 Meaningfulness: Making sense of the world, finding meaning and order in broader social organisation and in one's own life were also central to resilience (Laursen and Birmingham, 2003; Lev-Wiesel, 2008). This might be achieved through altruistic acts: Werner's Kauai study found that a desire to work to prevent or lessen the suffering of others was evident in resilient participants (1992), and this is echoed in studies which examined experiences of female survivors of various forms of childhood abuse, and in Colton et al's study of predominantly male survivors of ICA (Colton et al, 2002; Thomas and Hall, 2008; Werner, 1992). Several sources noted that spirituality is an important facet of resilience, providing, for some, comfort and strength (Hall, 2003; Heller et al, 1999; Laursen and Birmingham, 2003). This may be expressed by involvement with mainstream religion, or take the form of more generalised spirituality (Hall, 2003). As well as the comfort of faith, the former offers access to community support and relationships, as well as a forum for engaging in social activities (Laursen and Birmingham, 2003; Hall, 2003) which may promote feelings of self esteem and a positive self image. Moreover, recognition of a spiritual dimension offered some a means by which experiences of abuse could be effectively reconciled within a broader context, leading to a sense of acceptance and personal peace.

5.9 Hope: One resilience factor evident in several studies was the ability to look forward and see a positive future ahead, not just in terms of imagining life with an absence of abuse, but more broadly in terms of education, work and relationships (Hall, 2003; Laursen and Birmingham, 2003; Werner, 1992). This was associated with being able to perceive "achievable futures" (Hall, 2003, p654), which sparked ambitions and aspirations, and motivated persistence in pursuing them (Dearden, 2004; Hall, 2003; Hauser, 1999, Laursen and Birmingham, 2003). Werner (1992) characterised this as a general faith in the future. For the participants in Laursen and Birmingham's (2003) and Dearden's (2004) studies, both of which involved interviews with young people who had lived in residential care, a sense of optimism was externally reinforced by close and caring adults. Supportive adults played a significant role in "facilitating high expectations, and supporting participation in activities that afford opportunities for success" (Laursen and Birmingham, 2003, p246) and maintained "positive expectations of what [participants] could achieve in the future." (Dearden, 2004, p192). There was, therefore, an anticipation of a better future despite suffering hurt and trauma and, relating back to self image, a conviction that it was merited and achievable (Bogar and Hulse-Killacky, 2006).

5.10 These factors may be associated with the personal and internal aspects of individuals, and relate to how we see ourselves, the world around us, and also how we perceive the past, the present and the future. Yet they can be informed by people and events beyond the individual, and the literature reviewed for this study firmly contends that the quality and consistency of relationships are crucial to the development of resilience.

External/social

5.11 Following on from personal perceptions, this category addresses how individuals relate to and interact with others. The literature suggests that relationships with others provide a sense of interconnectedness: our personal relationships with those in our families and wider communities help to establish our place in the world, grounding us both in our particular social environment and in broader society (Hauser 1999; Heller et al, 1999). This section discusses how social interactions affect resilience, and illustrates their reciprocal relationship with personal perceptions and beliefs.

Relationships through the lifespan

5.12 The literature reviewed focused on individuals at many different points in the lifespan, from childhood through adolescence and into adulthood, and consistently identified the quality of relationships as a pivotal influence on resilience (Collishaw et al, 2007; Daniel et al, 1999; Daniel, 2008; Gilligan, 2008; Heller et al, 1999; Laursen and Birmingham, 2003; Perkins and Jones, 2004; Roman et al, 2008; Rutter, 2000). Supportive relationships appear to be crucial throughout the lifespan, in terms of reinforcing protective factors such as self esteem. Laursen and Birmingham (2003) interviewed 23 young people in the US in order to examine the potential protective role caring relationships might have, and found that such external relationships, particularly with adults, were vital. This is echoed in studies which focus on the quality of relationships between adults: for example Roman et al (2008) found supportive interpersonal relationships were crucial to the resilience of female survivors of childhood sexual abuse in their American study of 44 women survivors. This suggests that relationships might be pivotal throughout life, and may even mitigate the negative impacts of adversity, including experiences of abuse, providing support to safely reflect upon and process negative experiences, and potentially accelerating recovery (Gilligan, 2008; Roman et al, 2008; Rutter, 2000).

Early years relationships

5.13 A close, supportive, committed relationship between a child and at least one trustworthy adult was critical to the longer term development of resilience. Bowlby's attachment theory outlines the role of the relationship between a young child and its primary care giver in influencing levels of self esteem, a sense of security and longer term social aptitude as the child grows older (Heller et al, 1999). For children and young people, the quality of parental and familial relationships might be important (Collishaw et al, 2007; Daniel, 2008; Laursen and Birmingham, 2003; Lev-Wiesel, 2008; Roman et al, 2008). However the majority of papers referred more generally to the role of relationships with significant adults, who may or may not be relatives (Daniel et al, 1999; Daniel, 2008; Dearden, 2004; Gilligan, 2008; Heller et al, 1999; Jackson and Martin, 1998; Werner, 1992). In the absence of, or as a complement to, a healthy relationship with at least one parent, adults outwith the family can be effective role models and mentors (Daniel, 2008; Dearden, 2004; Jackson and Martin, 1998). Such adults "can provide [children] with the secure basis for the development of trust, autonomy, and initiative" (Werner, 1992, p267), particularly if relationships are based on unconditional acceptance, and offer non-judgemental support, encouragement and understanding (Laursen and Birmingham, 2003; Werner, 1992). Ideally, good interpersonal relationships with a range of people, peers and adults both within and outside a child's family, provide the security, stability and continuity associated with the development of resilience (Collishaw et al, 2007; Perkins and Jones, 2004; Daniel et al, 1999; Dearden, 2004; Lösel and Bliesener, 1990). These wider social networks, premised on reciprocal caring, offer opportunities to develop social skills, to respond to expectations, and to learn to cope with responsibilities in safe, secure environments (Daniel et al, 1999; Dearden, 2004; Gilligan, 2008; Lösel and Bliesener, 1990; Werner, 1992).

Adults and relationships

5.14 The literature reviewed underlined the importance for adults of caring, supportive relationships with others in the ongoing process of coping with the effects of childhood maltreatment (Collishaw et al, 2007; Hall, 2003). Roman et al (2008) identified two types of relationships with key adults that proved particularly important to the participants in their qualitative study of adult female survivors of childhood sexual abuse: 'no matter what' connections, which provided long term "constancy, reliability and acceptance" (p191); and 'saw something in me' bonds, which increased self esteem through a sense of being loved for "uniqueness or competence" (p190). Collishaw et al, whose secondary analysis study focussed on adults who had experienced physical and sexual abuse in childhood concluded that good quality relationships, including friendships, which occurred throughout childhood and continued into adulthood were important (2007). While many of the papers discussed this in relation to children and young people, several papers highlighted the continuing importance of peer relationships into adulthood, and how experiences earlier in life shape the way in which an individual "seeks, recruits, and maintains ties with others" (Hauser, 1999, p14) as life goes on beyond traumatic experiences (Collishaw et al, 2007; Smith-Osborne, 2007; Roman et al, 2008).

5.15 The first two sections of this chapter demonstrate the personal and social factors associated with resilience which interact with one another, shaping resilience in individuals. Moreover they demonstrate the integrated nature of the personal and the social throughout the lifespan: factors which affect resilience in children are also relevant for adults. What happens in childhood affects resilience beyond childhood, throughout youth, and into adult life, demonstrating the longitudinal nature of the process. However, the individual cannot be excised from his or her social environment, and the literature also refers to structural factors which might affect resilience; the following section discusses these.

Structural

5.16 Ungar (2005) cites Guerra (1998) who argues that risk and protective factors associated with resilience are influenced by individual socioeconomic contexts: categories of difference which shape identities and through which power is exercised, such as class, gender and race, inevitably mediate perceptions, values and attitudes. Overarching social, political and economic constructs frame individual experiences, and therefore cannot be overlooked when trying to understand them; indeed, Werner's original research identified poverty as a risk factor associated with compromised resilience. Yet the literature reviewed for this study did not explicitly discuss structural factors. Dearden (2004) suggests that the shift of emphasis from risk factors embedded at socio-political structural levels towards effective interventions at individual levels has been motivated by pragmatism since "in many cases it is more realistic to do this than to eliminate risk" (p187). Nevertheless, some papers refer to the role of participation in paid work, for example, as a means to elevate self esteem and promote social inclusion (Gilligan, 2008) potentially contributing to a sense of meaningfulness in one's life, and the raised risk of unemployment and homelessness among adult survivors of abuse (Wolfe et al, 2006; Colton et al, 2002). However, while the sampled literature touched briefly on issues of poverty and aspects of social identity such as race and ethnicity, gender was the factor which was most frequently discussed.

5.17 Abuse causes suffering to all individuals who are subjected to it, irrespective of gender (Collishaw et al, 2007). However there were gendered differences apparent in the literatures which have implications for recovery trajectories, relating to some of the factors outlined in the previous sections (Colton et al, 2002; Gilligan, 2008; Werner, 1992).

5.18 Although it was not a specifically gendered study, Werner's work in Kauai highlighted gendered risk factors which influenced the resilience of participants: teenage motherhood for girls, and 'delinquency' for boys - criminal records were almost three times as common among boys than girls - and concluded that boys were especially at risk of encountering longer term problems in coping with a range of childhood adversities (1992). The majority of papers included in this study researched non gender-specific populations, and of the gender-specific remainder, five were based on the experiences of women survivors while only two focussed on those of men. In contrast with an extensive body of predominantly feminist research which has studied women's experiences of diverse forms of abuse in a variety of contexts, there is a dearth of research on men's experiences of abuse and recovery (Wolfe et al, 2006; Roman et al, 2008). Although the scale of this study prevents drawing definitive conclusions, reflecting on the differential recovery trajectories of men and women described in the literature permits tentative speculation about the potential impact of gender on resilience.

5.19 Lev-Wiesel's study (2008) examined the experiences of 52 male and female adult survivors of paternal sexual abuse, synthesising this data with that from a larger survey of 93 female survivors of childhood abuse, to reveal significant gender differences in perceptions of culpability: while more men than women blamed their abuse on the personality of the perpetrator or attributed it to the negative circumstances in which it occurred, 40% of male participants blamed themselves, compared to less than 20% of the women (pp151-152). Given that externalisation of blame appears to be a critical factor in recovery from abuse (ibid) and the consequent development of resilience, this could hamper some men's ability to recuperate in later life, encouraging internalisation of blame, driven by feelings of shame and guilt.

5.20 Although both male and female survivors of abuse frequently suffer longer term impacts on their mental health and physical wellbeing, a significant gender difference found in the literature relates to relationships. While women had a preference and aptitude for forming close, informal friendship networks, men tended to favour more formalised, less intimate social connections (Laursen and Birmingham, 2003; Gilligan, 2008; Roman et al, 2008). The participants in Wolfe et al's study, 76 men who had experienced childhood abuse in Irish institutions, expressed intense difficulties in forming and sustaining close, meaningful relationships in adulthood. This has direct significance for resilience, since warm and caring relationships are so critical for its development (Wolfe et al, 2006).

5.21 There is therefore the basis for an argument that gender is an important factor in resilience. This conclusion should be considered cautious however: there were no comparative data in the literature reviewed specifically relating to male survivors who demonstrated resilience, nor on women who did not. Nevertheless, there is some evidence of gendered dimensions to resilience which might prove fruitful in expanding our knowledge and understanding of successful recovery processes, and of adult survivors more generally, and which to date remain under-researched. Moreover, while gender was the main social characteristic discussed in the literature sampled for this review, other categories of social identity, such as class and race, alongside other structural issues such as allocation of public resources - the availability of easily accessible and adequately funded service support for example - are likely to be of equal relevance to resilience and would benefit from closer attention (Ungar, 2005; Smith-Osborne, 2007).

5.22 This chapter has outlined and discussed the various factors affecting resilience identified in the literature reviewed. Although organised under discrete headings, the interactive nature of all of these factors is consistently reiterated, and as such it might be useful to perceive them as discrete threads, none of which make an individual more or less resilient on their own, but instead interweave to create unique "patterns of recovery" (Hauser and Allen, 2006, p553) across the lifespan. The literature highlighted that research into resilience has increasingly focussed on the experiences of specific population groups, but so far these have not included survivors of ICA (Simpson, 2010). The following chapter discusses resilience in relation to this group, and suggests how the concept might aid understanding of their disparate survival stories.