DOCUMENT RESUME CG 031 626 ED 463 472 AUTHOR West, Cheryl D. Pathways of Thriving and Resilience: Growth Responses to TITLE Adversity and Trauma in Two Cambodian Communities: A Comparative Study between Lowell, Massachusetts and Phnom Penh, Cambodia. PUB DATE 2000-00-00 127p.; M.A. Thesis, University of Massachusetts Lowell. For NOTE related thesis abstract, see ED 461 073. Masters Theses (042) Information Dissertations/Theses PUB TYPE Analyses (070) Reports Research (143) EDRS PRICE MF01/PC06 Plus Postage. *Asian Americans; Attitude Measures; *Cambodians; *Coping; DESCRIPTORS Cultural Context; Emotional Disturbances; Foreign Countries; Individual Development; Posttraumatic Stress Disorder; *Refugees; Research; *Resilience (Personality); Social Support Groups; *Stress Variables; War *Cambodia; Massachusetts (Lowell); Traumas IDENTIFIERS ABSTRACT This qualitative study investigated individual, contextual, and cultural factors that promote trauma-related resilience and positive growth among Cambodian survivors of the Pol Pot regime who reside in Phnom Penh, Cambodia and Lowell, Massachusetts. A thriving paradigm framed semi-structured interviews that were conducted with 21 Cambodians in Phnom Penh and 21 Cambodians in Lowell. This study reports on the use of the Stress Related Growth Survey, the Posttraumatic Growth Inventory, and the Thriving Scale in examining determinants of stress-related positive outcomes for Cambodian survivors. Content analysis was used to analyze case study data for significant predictors of thriving as well as cultural definitions of thriving and what resources support beneficial processes for Cambodians. Optimism, social support, self-reliance, access to education, and use of Buddhist principles were the major types of predictors of stress related growth, resilience, and thriving identified from the analysis. Cambodian participants reported that coping strategies played both a role in basic survival and later in transforming their profound losses and challenges into strengths. All participants reported that integrating a cultural context in community programs, social resources, and health services are important factors, which support healing and encourage positive growth outcomes for Cambodians. (Contains 51 references.) (Author/JDM) Reproductions supplied by EDRS are the best that can be made from the original document. Pathways of Thriving and Resilience: Growth responses to adversity and trauma in two Cambodian communities: A comparative study between Lowell, Massachusetts and Phnom Penh, Cambodia Cheryl D. West B.S., University of Oregon 1994 SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN COMMUNITY/ SOCIAL PSYCHOLOGY UNIVERSITY OF MASSACHUSETTS LOWELL 2000 BEST COPY AVAILABLE U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement PERMISSION TO REPRODUCE AND EDUCATIONAL RESOURCES INFORMATION DISSEMINATE THIS MATERIAL HAS CENTER (ERIC) BEEN GRANTED BY O This document has been reproduced as received from the person or organization C\ originating it. O Minor changes have been made to improve reproduction quality. 2 TO THE EDUCATIONAL RESOURCES Points of view or opinions stated in this document do not necessarily represent INFORMATION CENTER (ERIC) official OERI position or policy. Table of Contents page List of Tables vii Chapter 1: Introduction 1 Chapter 2: Literature Review 3 Pathologizing Refugees 5 Trauma 7 Cross Cultural Models of Diagnostic Criteria 9 Refugee Resilience 12 Thriving Concepts 14 Theoretical Models of Thriving 16 Literature Summary 20 The Current Study 23 Southeast Asian Socio-historical Perspective 25 Buddhism 27 Statement of the Problem 29 Purpose of the Study 31 Case Study Design 34 Chapter 3: Methods 37 Procedures 37 Participants 39 Materials 41 Measures 44 3 iv Analysis 45 Chapter 4: Results 48 Description of the Participants 48 Trauma Experiences 57 Loss 58 Trauma 61 Torture 62 Illness 63 Separation from Family 63 Death 63 Post Khmer Rouge Adversity 64 Phnom Penh Adversity 65 Lowell Adversity 67 Coping Strategies 69 Pathways of Growth, Resilience and Thriving 70 Self Perception 71 Relationship with Others 74 Life Philosophy 75 New Pathways 79 Chapter 5: Discussion 87 Trauma, Loss, and Adversity 88 Coping and Survival Strategies 89 Pathways of Step by Step Growth 90 Community and Social Factors of Resilience and Thriving 90 Cambodian Model of Resilience and Thriving 92 Methodological Limitations 94 Researcher Experience 96 Conclusion 99 Community and Social Psychology Roles 100 Community Implications 102 Future Questions 104 References 106 Appendices 110 Biographical Sketch of the Author 119 vi List of Tables Page Characteristics of Participants 1. 40 Items in the Thriving Scale used in Interview 2. 42 Pathways of Growth 3. 85 List of Diagrams 1. Westermeyer Model of Western versus Traditional Definitions 10 2. Schaefer and Moos Model of Life Crisis and Personal Growth 17 3. O'Leary and Ickovics Resilience and Thriving Model 17 4. Tedeschi and Calhoun Trauma and Transformational Model 18 5. Aldwin Transformational Coping Model 19 6. Cambodian Model of Resilience and Thriving 93 vii Acknowledgments First and foremost, I am greatly indebted to the many courageous, resilient Cambodians who risked "opening their hearts" while sharing their stories of profound loss and trauma that were transformed to stories of exceptional triumph and victory. I will forever be inspired by the "step by step" paths of survival and healing chosen by so many Cambodian mentors of resilience who suffered and endured beyond comprehension. May joy and peace grace their pathways as they continue "step by step" to build on lessons learned. During the course of both the research and the writing of this thesis many gave invaluable assistance and guidance. I would like to express my sincere gratitude to my thesis committee, Dr. Bill Berkowitz, Dr. Jon Hellstedt, and Dr. Linda Silka for serving as beacons of light on my thesis journey. Special appreciation is given to Dr. Linda Silka, the inspirational, mentor for many, whom I learn from daily and deserves inexpressible gratitude. She provides continuous guidance and support while exemplifying a gifted teacher who models how to learn and evolve in every moment. A million thanks to Chath pier Sath, my cherished friend and collaborator, who shared the journey making it possible, while splashing zany strokes of humor and laughter amidst challenging landscapes and processes. I would also like to thank Tooch Van for translating research instruments and materials. Ongoing gratitude goes to my friends for encouraging me, my children for believing in me, and my mother for sharing in the joys of each step taken on this exciting path. I also wish to express my gratitude to Dr. Lawrence Calhoun, Dr. Richard Tedeschi, Dr. i'ma-Abraido-Lanza, Dr. Lawrence Cohen, Dr. Murch and Dr. Crystal Park for su generously sharing their instruments, recent literature, thoughts and interest. In addition, I also wish to thank Ellen Minotti at Social Services, in Cambodia for assisting Chath and myself, offering constructive criticism, sharing her work in Cambodia and trusting in this thesis material. Abstract This qualitative study investigated individual, contextual, and cultural factors that promote trauma related resilience and positive growth among Cambodian survivors of the Pol Pot regime who reside in Phnom Penh, Cambodia and Lowell, Massachusetts. A thriving paradigm framed semi-structured interviews that were conducted with twenty- one Cambodians in Phnom Penh and twenty-one Cambodians in Lowell. This study reports on the use of the Stress Related Growth Survey (SRGS), the Posttraumatic Growth Inventory (PTGI) and the Thriving Scale (TS) in examining determinants of stress-related positive outcomes for Cambodian survivors. Interview content, based on these three instruments was culturally modified to explore factors of stress-related positive outcomes. Content analysis was used to analyze case study data for significant predictors of thriving as well as cultural definitions of thriving and what resources support beneficial processes for Cambodians. Optimism, social support, self-reliance, access to education, and use of Buddhist principles were the major types of predictors of stress related growth, resilience, and thriving identified from the analysis. Cambodian participants reported that coping strategies played both a role in basic survival and later in transforming their profound losses and challenges into strengths. All participants reported that integrating a cultural context in community programs, social resources and health services are important factors which support healing and encourage positive growth outcomes for Cambodians. 1 Chapter 1 INTRODUCTION During the last several decades, the international aid community has responded to the aftermath of numerous civil wars. Responding to psychological stress and disrupted systems of support has been a challenging aspect of this task. Numerous organizations and researchers are investigating how individuals and communities are affected by wars; they are investigating the relationship among social conflict and psychosocial distress and cross-cultural responses (Marsella, Friedman, Gerrity, & Scurfiled, 1996; Marsella, Bornemann, Ekblad, & Orley, 1994; Nader, Dubrow, & Stamm, 1999; and Utting, 1994). Challenges faced by the international community are many. They include how to create a balance between culturally ingrained methods of coping and external, often foreign strategies; how to empower natural but damaged support systems; and how to fully understand refugee coping processes. In response to these challenges, investigators have begun to engage in a learning process that integrates the centrality of culture that investigate methods of indigenous healing that examines how suffering and illness are perceived, and that considers how traumatic stress is affected by a range of micro to macro conditions such as individual characteristics, family relationships, socio-economic factors, cultural influences, and community resources. Considering the emerging cross-cultural challenge reflected in the refugee experience, the research reported here was designed to investigate the ways that Cambodians are coping with multiple adversities and trauma. Through this work we will 9 2 investigate what resources were helpful in recovery and life rebuilding processes, and identify stress-related growth outcomes that facilitate resilience and thriving. The goal of this research was to assess perceptions and factors of resilience and thriving among Cambodians in Phnom Penh and Lowell. Enhanced understanding of paths taken by individuals who exhibit Cambodian resilience will be shared with the Lowell community and be used to suggest roles that community and social psychologists can take in training and program development. This report is based on field research conducted in Phnom Penh, Cambodia and Lowell, Massachusetts over a period of eight months from July 1999 to February 2000. It draws on both primary and secondary Cambodian interviews and resources. Forty-two Cambodians, identified as resilient, were interviewed to gather in depth primary information about their coping strategies and mediating influences that resulted in new personal strengths. The verbatim transcripts were analyzed to identify themes pertinent to stress related growth. In addition, twelve Cambodian secondary resources contributed material and information relative to a Cambodian context and views on Cambodian psychosocial issues. As is perhaps the case with any single study, the findings are partial rather than comprehensive. In the following chapter, theoretical assumptions relevant to refugee trauma and resilience are outlined. In Chapter 3, an explicit description of the procedures for this study is presented. Chapter 4 summarizes the study's main findings, which is followed by a discussion of the results in Chapter 5. The concluding section suggests future research and constructive roles for community and social psychologists. 1 0