Hello, in, in this segment we're going to discuss resilience in the context of war. The drawing you see here on the opening slide is a drawing by a former child soldier that was shared with me by Theresa Betancourt. We're going to talk about some of her work. We're also going to talk about two other research projects that illustrate the kind of research that's been done to try to understand resilience and recovery, in young people who survived war. The first project I want to talk about comes from some of the work I've done with colleagues, with Cambodian survivors of the genocide in Cambodia, that was perpetrated by the Khmer Rouge under Pol Pot between 1975 and 1979. Where I live in Minnesota, it's a part of the United States where many refugees have come from war torn countries. And we offer a lot of opportunities and services for young people who've been through these kind of experiences. Well a while ago, I was giving a talk with my colleague, George Riomudo, who's a child psychiatrist to a group of community people and they approached us after we gave our talks on resilience and asked if they, we would help them. Try to understand the needs of Cambodian youth who had survived the time during what has been called the killing fields, and we agreed to do that and work collaboratively with community members and several other colleagues and students to try to understand the risk, and protective factors in the lives of these young people, to try to provide information that would help our community know what to do to support their positive development. I want to focus on some dissertation work of two of my students, Jon Hubbard and Andrea Northwood, and I'll tell you why in a few minutes. Here is an example of the kind of experiences these young people, survivors of the war in Cambodia had experienced, and they were extreme. There were 25 items on this Traumatic Life Events Questionnaire. And these young people had experienced an average of 12 of these experiences. And I just put up a few examples here so you could see the kind of traumatic events that had occurred in their lives. For example, over 3 4ths of the young people had seen dead bodies, more than 3 4ths of them knew somebody who starved to death. As in many wars, starvation was a big issue. During the time of the Khmer Rouge. Many of them had seen their relatives killed. A lot of the parents of these young people had been taken away, often never to return. Half of them had seen somebody tortured. And a quarter of these young people had, had somebody torture them, their selves. So, there was a tremendous amount of adversity. We were meeting with them, and working with them in this research, more than ten years after this war had ended. So they were, they had been young children at the time and now they were adolescence, and young adults. And we were very interested to know how they were doing now. And we assessed both their competence and their trauma symptoms. We assessed whether they had post traumatic stress disorder, and other disorders like depression. That are often associated with this kind of extreme exposure to violence. And we did find that a lot of these young people still had trauma problems. A third of them at the time we did our assessment, many years after their trauma experiences, currently met the criteria for post traumatic stress disorder. And many others of the them had experienced PTSD at some point during their lifetime. We also observed quite a bit of depression. Depression often accompanies post traumatic stress disorder in the wake of these kinds of terrible experiences. And we also observe that if the young people had either trauma symptoms or depression now, they also were struggling in the areas of adaptive functioning that we have talked about as developmental tasks, what you might call competence in their everyday life. We also looked to see if the degree of trauma they had experienced was related to how they were doing now, and we did find that there was very little connection. Even though trauma in the past was a good predictor of the risk for post traumatic stress symptoms, it did not predict current functioning very well. What predicted current functioning was whether you were having symptoms now of mental health problems, so that suggested to us that was tremendous variation among the young people who survived the terrible experiences during the Khmer Rouge regime. So we were very interested in their resilience. And, we did a number of projects to try to understand their resilience. And some of the basic things we learned are listed here, as important protective factors for the wellbeing and resilience of these young war survivors. One of the most important factors was how well they were able to learn the language of their new country. In in this case, the English language. Because that provides a tremendous, asset for doing well in school or in work. Another factor was community support, where the young people connected either to family or to other people who had taken them in and were providing support to them. And the third area that was really important was culture. One part of this was acculturation, how well were they doing in their new culture. Did they feel connected? And the young people who are doing well, felt connected to the American culture, and comfortable in this culture. And for some of them, they also felt very connected to the Khmer culture as well. So either bicultural connectedness or connection to the American culture, feeling American, were predictors of doing well in this new country. We also found that some of their cultural tra, traditions were important. And many of these young people were Buddhist in their upbringing, and many of them had learned meditation techniques. And we think that this may have played a role in helping them calm themselves, during very difficult times. Here's a photograph of my two former students, Andrea Northwood and John Hubbard. And they have gone to work, for many years now, for the Center of Victims of Torture, which is located in the city of Minneapolis here in Minnesota. And the center was founded in 1985. It was one of the first centers to help people who have survived war trauma and torture, in the western hemisphere. It was modeled on other centers around the world. And this, these two students, as well as many other staff at this center do a lot of training, globally and locally, to try to help others understand and work with war survivors. It's a very important kind of work and some of their teams, including one of John's teams, have received awards for their work overseas in refugee camps. The second project I want to tell you briefly about has been conducted by Theresa Betancourt, and she's a professor at Harvard who's done e, extensive work in Sierra Leone with war survivors, and particularly with child soldiers. Her work is very well known because, it's some of the most unusual longitudinal research done with child soldiers as they've been integrated back into society. And this is a photograph that she shared with me, so I could talk about her work with you. Betancourt and her colleagues are following a large number of war survivors and, most of them child soldiers from Sierra Leone, over time. And they've been following these young people for a long time now. In fact, these young people have grown up, and they're now beginning to follow them as they form their own families and have their own children. This is, is an extremely unusual and important body of work. And right now, her she's reporting on about over 400 of these child soldiers for whom she has data over time. And like the Cambodian survivors, these child soldiers and young people who, who've survived one of the most brutal wars in recent memory have had terrible experiences. The young people have witnessed horrendous violence, but they also, in some cases, have perpetrated violence, killing and injuring others when they were child soldiers. These young people also met, many of them have experienced the death of a parent, they've been the victim of rape, and even after the war, they've experienced a lot of trauma. Many, in many times and situations, child soldiers face the stigma. And discrimination, as do young people who've experienced rape. And, if you experience this kind of rejection when, during the process of recovery, it is a huge risk factor, for ongoing problems. Also, a number of these young people, when they came back, did, didn't find the kind of support they needed, and instead came back to families where there was violence, and ongoing abuse or neglect. However, when there was family and community acceptance, as well as opportunities for work, and education, these young people have recovered very well. And I want to show you one of the graphs from Theresa's work. This was reported in one of the leading Journals in Child Development in 2013. This is a report on longitudinal data. From some of her work with those young people, that was I was just describing. And what she's done here is looked at the trajectory of their development over time. And she's extracted four patterns, that show the different pathways that young people followed in this cohort. And what you can see at the top here, is children who have not done very well. What we're measuring here is internalizing symptoms. These are symptoms of distress, anxiety and depression, so having a high score means you're not doing very well. And this group, had high symptoms at when they were, this is after the war, they had high symptoms when they began their work in 2002 and they've continued to have a lot of symptoms over time. So they're not doing well. But you'll notice that this is only five percent of the overall group of these war survivors. This group in contrast, started off with high symptoms, but they've been improving over time. And you'll notice there that 48% have followed this kind of pattern, which is really encouraging. The next pattern down is a pathway of deterioration, where there's low symptoms at the beginning of their assessment, and then the symptoms get worse over time. Clearly, this is not a good pattern, and it's probably associated with poor conditions for recovery. And you'll notice again that only six percent, had this kind of pattern over time. And the final group is kind, is you might view as the stable resilience group. This group has had lowest symptoms from the first time they did the post war assessment, and they've continued to have a stable pattern of low symptoms. So, what's striking about this graph, is both that you have these different patterns of, of change over time. But also that around 88% of all these young people who have experienced terrible war experiences and trauma, are doing well in terms of this kind of symptoms. And she's continuing to look at other symptoms, and also continuing to follow these young people through time. Now she's been doing her work for or, over a decade. And, she is now moving to devel, developing interventions that will help the young people and facilitate their resilience. And she's developed an intervention called the Youth Readiness Intervention, and this is a picture of the manual from that intervention. And this intervention is based on what they've learned in the first decade or so, of the work that they've done. And it's focused on trying to stabilized the lives of these young people, to integrate them into the community, and to facilitate connection. Because they see those processes as extremely important for the resilience of these youth from Sierra Leone. Now, she'll have to do more research to see how well this is working. But the early results look very promising. The third and final example I want to share with you is also a very culturally grounded, project that's been implemented by Catherine Panter-Brick in Afghanistan. As you probably know, this country has witnessed many, many years of conflict. And because of that, a lot of children and youth have got, have experienced many kinds of devastating war events. And what she has done with her colleagues, is developed very culturally appropriate assessments eh, that she could do in this country with collaborators there. And she did one study where she surveyed over 1,000 adolescents in Afghanistan. And what she learned is that, they, they certainly do appear to have been affected by this ongoing violence in this country, but that the, the protective factors she found are often embedded in the Afghanistan culture, and that young people appear to do much better when you see a lot of family resilience. And she's interested in the role of cultural values, and family functioning in the recovery and well-being of young people in countries like this. And she provided this quote that I think is very powerful from her work in Afghanistan, this is quoted from an Afghan mother who said that life feeds on hope. Hope, in, in their research has, appears to be an extremely important protective factor. She's not the only one that has found that. And we'll come back to that later on in this course. So all of this work in different war zones, studying young people who are recovering who are refugees or are continuing on in their country of origin, have broadly implicated some very similar protective factors. And by this point in the course, they're becoming very familiar. What seems to make a real, a big difference for war surviving young people is good family functioning, positive support from parents. Community support and integration, opportunities for work and school. Faith and religious practices, and also cultural values and practices. And, we're going to see these throughout many of the studies we're talking about in this course. Next, segment in this week's module is going to focus on resilience after terrorism.
