Updated: Dec 9, 2019
I've been interviewing candidates for medicine, for a few years now, and recently it occurred to me that they're great young people! I ask them all sorts of questions (which I'm not allowed to repeat outside those interviews, sorry) and they risk seeming stupid, nervous, anxious, unhinged .... yet, they come up trumps!
I was thinking that if the world of the future is in their hands, then it can't be all bad. I felt pretty confident!
Then, I went for coffee and a retired teacher expressed a view that was totally opposite! His recent experience had been to teach children with very difficult behavioural problems and learning difficulties. These young people had come from homes in which the adults also had similar problems, as well as poor parenting skills. In response, another at the table said, "ah yes, but children are very resilient".
Let me be clear: children are not naturally resilient.
Feeling like you belong is important to all of us, and especially to children
Lucy Allbaugh and colleagues interviewed low-income, suicidal, African American women who had experienced physical, sexual, and/or emotional abuse during childhood, and found that more abuse suffered or more types of abuse suffered, increased the likelihood of suicidal ideation or attempt. The participants who felt burdensome and experienced feelings of “thwarted belongingness” were more likely to attempt suicide.
Helle Harnisch and colleagues described in their research, children who were forcibly recruited into the northern Ugandan Lord’s Resistance Army, suffered torture, and were forced to kill their countrymen and women. Those children use avoidance as their preferred coping mechanism now they are adults. More generally, avoidance is a very common coping mechanism for people who have experienced severe stress and trauma. And what's more, it works - you don't feel horrible all the time (but you also miss out on opportunities for joy that might have associations with your triggers). Sadly, avoidance leads to worse outcomes in the longer term too ...
Resilient coping style: born with it, or into it?
Manfred Beutel and colleagues investigated childhood adversity, and found it was “associated with reduced adjustment, social support and resilience. It was also strongly associated with increased distress and somatoform complaints.” This means that if you are lucky enough to have a resilient coping style, then you will be better off than those without this coping style, in times of adversity. It also means that children who suffer adversity are also likely to suffer social and behavioural problems, emotional and learning difficulties, and they are less likely to pick themselves up and keep going when they experience a setback.
Nature or Nurture? Nurture!
Phillip Graham and colleagues reviewed the scientific literature to find out the experiences of boys and men of colour, who suffer trauma, and found that nurturing (by schools, police and communities) is required to protect and encourage optimal development. So, now we get into what everyone can do! Nurture!
Maria Muzik and her colleagues showed in recent research that social support helps to protect women who have been maltreated during their childhood from developing postpartum depression in later life. Yes, we can provide social support!
Jane Assher and colleagues interviewed mums and healthcare workers in a program designed to help Aboriginal mothers to develop strong attachments and parenting skills. They found that the therapeutic transformation can improve the mother/child attachment. This meant that an intervention which included all kinds of allied health professionals (like speech and occupational therapists) could be needed to help mum who had a trauma history to bond better with their bubs.
So, what is resilience? Let’s simply say that it is the ability to psychologically protect oneself from a challenging situation or person, so that your optimal development is not compromised in any way.
Do we all have it? Not really. If you are born into an environment where adversity is normal, you will probably go through life expecting the worst (and identifying it whenever it does). If you have a great family and education, supportive friends, and you never go without food, water, clothing and shelter, then you will probably go through life expecting the best (and hopefully you will be thankful when the good things happen). Generally speaking.
Some people can experience adversity and come out okay, while others might experience something less adverse, and end up with psychosomatic symptoms of illness and injury, or worse.
Gail Horner, in her educational article for paediatric nurse practitioners, referred to Mark Greenberg’s important research in saying “Three broad categories of protective factors have been identified: individual (temperament and intelligence/cognitive ability), the quality of the child’s relationships, and broader environmental factors (safe neighborhoods, quality schools, and regulatory activities).” (Page 384).
First, let’s tackle “regulatory activities”. Self-regulation is a quality we should all have. If we do, we are able to deal with whatever life throws at us, without getting too anxious. If, during childhood, we know the rules, and the consequences for breaking those rules (and the consequences are consistently adhered to), then we grow up with a sense of confidence in our environment. We learn all this by our parents and grand-parents, teachers and mentors telling us what we can and can’t do, and why (or why not). Imagine: adults as good examples! If it doesn’t happen, we develop anxiety and anxious behaviours.
Also, we all need to experience a little stress, and then get back to our normal self soon after, because this helps us learn (mentally and physically) how to deal with stress, and to know that we will be safe once the challenge is over. Remember the old saying, “It’s character-building”? A little stress is. It helps if we are fairly intelligent and can work out the process that is happening, instead of catastrophising or becoming superstitious.
Dealing with the little stress challenges means we can deal with the “tolerable” stress. Though, if we have to deal with the cumulative effects of many or repeated tolerable stress experiences, then we might not fare so well in the long-term. Little stress experiences are like being inoculated, but the same can't be said for bigger problems, like trauma.
If, as a child, we have to face abandonment, abuse, or other life-threatening adversity – and we cannot escape – we might not fare so well. This “toxic” type of stress feels inescapable even years after it has ended, because it has been experienced by a child (when everything is so much bigger).
What really helps in all scenarios is having a supportive caregiver there, to help you to feel safe. This is the important bit!!! We adults all have an opportunity to protect children from feeling unsafe. We can help them in their cognitive development – in learning how to figure things out in a sane way; we can help them to keep calm or to speak up as needed; we can help them feel like they belong, even if it is just as our neighbour or student; and we can help them to pick themselves up and dust themselves off whenever there is a smaller stressor to frustrate them. And, we can advocate on their behalf when they need higher level protection.
Thanks for allowing me the liberty of sharing my thoughts (and a little scholarly literature) with you! Hopefully, you are inspired to be a light to the children in your world.
I've used some scientific literature in this blog. If you're interested, here are the citations:
Allbaugh, L. J., Florez, I. A., Turmaud, D. R., Quyyum, N., Dunn, S. E., Kim, J., & Kaslow, N. J. (2017). Child Abuse - Suicide Resilience Link in African American Women: Interpersonal Psychological Mediators. J Aggress Maltreat Trauma, 26(10), 1055-1071. doi:10.1080/10926771.2017.1350773
Beutel, M. E., Tibubos, A. N., Klein, E. M., Schmutzer, G., Reiner, I., Kocalevent, R. D., & Brahler, E. (2017). Childhood adversities and distress - The role of resilience in a representative sample. PLoS One, 12(3), e0173826. doi:10.1371/journal.pone.0173826
Graham, P. W., Yaros, A., Lowe, A., & McDaniel, M. S. (2017). Nurturing Environments for Boys and Men of Color with Trauma Exposure. Clin Child Fam Psychol Rev, 20(2), 105-116. doi:10.1007/s10567-017-0241-6
Greenberg, M. T. (2006). Promoting Resilience in Children and Youth. Annals of the New York Academy of Sciences, 1094(1), 139-150. doi:10.1196/annals.1376.013
Harnisch, H., & Montgomery, E. (2017). "What kept me going": A qualitative study of avoidant responses to war-related adversity and perpetration of violence by former forcibly recruited children and youth in the Acholi region of northern Uganda. Soc Sci Med, 188, 100-108. doi:10.1016/j.socscimed.2017.07.007
Hornor, G. (2017). Resilience. J Pediatr Health Care, 31(3), 384-390. doi:10.1016/j.pedhc.2016.09.005
Muzik, M., Morelen, D., Hruschak, J., Rosenblum, K. L., Bocknek, E., & Beeghly, M. (2017). Psychopathology and parenting: An examination of perceived and observed parenting in mothers with depression and PTSD. J Affect Disord, 207, 242-250. doi:10.1016/j.jad.2016.08.035
Muzik, M., Umarji, R., Sexton, M. B., & Davis, M. T. (2017). Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity, Economic Adversity and Postpartum Depressive Symptoms. Matern Child Health J, 21(5), 1018-1025. doi:10.1007/s10995-016-2197-4
Ussher, J. M., Charter, R., Parton, C., & Perz, J. (2016). Constructions and experiences of motherhood in the context of an early intervention for Aboriginal mothers and their children: mother and healthcare worker perspectives. BMC Public Health, 16, 620. doi:10.1186/s12889-016-3312-6