Sunday, April 27, 2008


Ethnographic Methods for Disaster Mental Health in Low Resource Countries

Laura Murray and Paul Bolton have worked together to develop a model for how to conduct high-quality research (including a randomized and controlled trial) and service delivery in culturally appropriate ways in low-resource countries. Their approach begins with a relatively quick (three weeks or less) ethnographic and qualitative study to help identify culturally specific definitions of distress and inform the selection of measures and interventions. This article describes this ethnographic phase in detail, and discusses the utility of using it in interventions designed to reduce the impact of disasters.

Here is their article:
Bolton, P., & Tang, A.M. (2004). Using ethnographic methods in the selection of post-disaster mental health interventions. Prehospital and Disaster Medicine, 19(1), 97-101.

Monday, April 07, 2008


Resilience is Universal… and Not Really

One part of being scientific-minded means being skeptical and contrarian. So I am going to challenge resiliency on a website so dedicated to Resiliency.

A subtle premise of many unscientific resiliency workshops and trainings is that “Everyone is Resilient.” This myth finds itself in crisis against the real finding that some damage strikes very deep.

Childhood Trauma, the Neurobiology of Adaptation & Use-dependent Development of the Brain is a field-changing article in which Bruce Perry, et. al. argues that our brains (particularly young brains) cannot always be resilient. Brains can be malleable -- adapting to trauma in ways that only make sense in the context of horror. This malleability can account for the inexplicable and sometimes unsavory behavior of people who have been secretly affected by trauma.

The non-scientist (layperson) will enjoy reading paragraphs #2, #3 and then review the “Key Points” at the end of the article.


Resilience is Universal… and Not Really, Part II

Bruce Perry, MD, PhD, the lead author of the Childhood Trauma article referenced earlier, is a child psychiatrist and brain scientist at Baylor College of Medicine. I attended medical school at Baylor, and when Perry taught, his passion for preventing trauma and safeguarding children made a deep impression on us.

While resiliency should be bolstered in all reasonable and rational ways, we must keep another eye towards preventing traumatic stimuli; because bouncing back from every trauma may not be neuro-biologically possible. It is useful to know that traumatic stimuli -- even in the absence of a physical blow or injury -- induce a cascade of neurotoxic insults to brain tissue. Sometimes we can clear the toxin, and sometimes our coping skills are overwhelmed.

Equally important, if we believe that resiliency is possible for everyone, then we secretly judge those who do not demonstrate resiliency as weak or “not trying hard enough.” While resilience is of the utmost importance to pursue, we in the field should never confuse non-recovery from trauma as evidence of failed resilience.

Our duty in trauma work is to temper the discourse of resilience with the reality that some people do not recover. Prevention being the best medicine is why those of us who work in trauma recovery are indebted not only to appropriate law enforcement, but also to the champions of human, civil, and children rights.

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