Abstract
Historically, psychiatry and clinical psychology focused on understanding how stressful life conditions led to psychiatric disorders. With the rise of positive psychology, the focus shifted to thriving through adversity and to concepts such as resilience. However, the number of mental disorders is still increasing. Due to a neoliberal Western decontextualizing stance in psychology, the concept of resilience is at risk of reproducing power imbalances and discrimination within our society. Resilience is analysed from a critical perspective, mostly with a Marxist point of view, including Foucauldian discursive approaches, as well as a biomedical critique of the current mental health system, to illustrate the shortcomings of Western psychologies. This article illustrates how a contextualized understanding of resilience that accounts for political, historical, and socioeconomic contexts at analytical levels besides the individual may overcome this ethnocentric and neoliberal bias.
Formulating a critical framework
Resilience has become a buzzword, apparently important to everything from mental health to national security, unemployment to climate change (Hammond, 2014). Traditionally understood as a prevention of disasters or a capacity for individuals or systems to manage and rebound from a disruption, the concept has migrated from the natural and physical sciences into the social sciences and public policy as the identification of global threats such as economic crisis, climate change, and international terrorism has focused attention on the responsive capacities of places and social systems (Hill, Wial, & Wolman, 2008; Swanstrom, Chapple, & Immergluck, 2009). Historically, the disciplines of clinical psychology and psychiatry analysed how strain and adversity lead to relevant clinical burdens in a person. It was only later that the positive aspects were recognized as well. This is in line with the rise of positive psychology and related concepts such as resilience. However, prevention has proved elusive, with mental health diagnoses becoming more, not less, common.
Several scientists highlighted neoliberal, universalist rationalities containing a causal logic associated with the dominant concept of resilience (Chandler, 2014; Joseph, 2013). Chandler (2014) analyses the concept in the field of governance and policies. According to him, most universalist top-down institutional and legal measures fail to produce the intended results simply because of a lack of local sensitivity and engagement. Chandler therefore demands a post-classical understanding of resilience that accounts for cultural and local contexts and related complexities. Similarly, this article investigates the contemporary usage of resilience in mainstream psychologies. Due to a decontextualizing tendency in Western mainstream psychologies, the concept of resilience may be at risk of reproducing power imbalances and discrimination within our society. This article explores the concept of resilience to illustrate the shortcomings of universalist approaches in clinical psychology and psychiatry from a critical framework. It highlights alternatives that account for contexts and structural inequalities. Instead of a blanket critique of neoliberalism, it attempts to identify the problematizations around which resilience appears as a solution; the kinds of explanations of problems that resilience provides, notably the centrality of the idea of vulnerability; the specific technologies being developed to enhance resilience; the forms of expertise that are taking shape to define and manage it; and the conceptions of personhood and techniques of the resilient self that are being put into place. (Rose & Lentzos, 2017, p. 43)
The theoretical framework used in this article mostly contains a Marxist point of view, including Foucauldian discursive approaches, as well as a biomedical critique of the current mental health system to illustrate the shortcomings of many Western psychologies.
“Critical thought in any domain is essentially about questioning what is currently understood to be the common sense in that domain” (Bracken & Thomas, 2017, p. 98). This includes ontological questions about what sort of entities exist and how they can be classified and understood; for example, where does resilience and the lack thereof, that is, vulnerability, come from? It also refers to epistemological questions, such as what kind of knowledge is appropriate in the field of mental health and resilience? This strong focus on evidence-based treatments is usually referred to as positivism—that is, the assumption that psychology, sociology, anthropology, etc. are only scientific if they apply the same scientific approach that is used in the natural world such as biology, chemistry, and physics. Positivism includes causal assumptions and the quest for universal laws disregarding contexts. A critical approach also refers to empirical and therapeutic questions, for example, what maintains and increases resilience and how does it work? This leads to the consideration of ethical issues and how a therapist should position him or herself when it comes to pharmacotherapy, and the biomedical model that helps to legitimate the vast consumption of pharmaceuticals (see Bracken & Thomas, 2017).
Marxist theory illustrates how neoliberalism and capitalism impact psychological practice and thinking (see Cohen, 2017a). Neoliberalism is a major macro cultural factor that has been systematically restructuring all social institutions and cultural concepts. Marxist theory prioritizes the structural dynamics of capitalism and how it impacts mental health, assuming that the working-class is exploited for the sake of the ruling class. Economic resources are fundamentally unevenly distributed between the elite and the masses. Growing rates of mental illness are considered to be an inevitable consequence of the oppressive and exploiting economic conditions under capitalism. The alienating factor of capitalism is treated as an explanatory variable for mental illness. Characteristics of the mental health business itself also contribute to the growing number of mental disorders, according to Cohen (2017a)—namely, profit accumulation and social control are crucial to the mental health system. Since de-institutionalization in the 1960s and 70s, an increasing deregulation of the market took place, including a rapid expansion of private mental health services. Enormous profits are made with a multitude of therapeutic services and drug treatments as a new “trade in lunacy” (see Scull, 2015).
In a Neo-Foucauldian sense, psychological concepts such as vulnerability and resilience may aid the self-surveillance of the subject and inform the limits of our conduct in contemporary society: “the mental health system can now be considered as an ideological tool of capitalism which normalizes the ongoing oppression of the majority of the population through a psychiatric discourse which has become totalizing – or ‘hegemonic’” (Cohen, 2017a, p. 50). The mental health system, with its division between sick and healthy, vulnerable and resilient, is considered as a key institution of social control. Psychiatric diagnosis, the labelling of resilience and vulnerability, functions as a political device legitimating a particular response to aberrant behaviour. The mental health system, clinical psychology, and psychiatry, are the rule makers for acceptable behaviour by naming and specifying what is “mad,” “aberrant,” and “vulnerable.”
Most Western psychologies are known for their person-centredness (i.e., when personal traits such as self-efficacy and hardiness are highlighted). This is in contrast to the widespread acknowledgement of a person–environment interaction that was the foundation of the contemporary stress and emotion theory, which emphasizes the relational meaning that individuals construe from their transactions with the environment (Lazarus, 1998, 1999). Neoliberal discourse fosters individualization and the virtue of competition and consumerism are upheld instead of social ties, solidarity, and harmony (Cohen, 2017a). In line with positivism and the quest for universal laws, diagnostic entities decontextualize people’s problems and then recontextualize them by inventing a concept called disorder. Burstow (2017) describes this ideological circularity with the example of selective mutism: “Selective Mutism” is a diagnosis given to people who elect not to speak in certain situations. So, if I were … trying to get a handle on what’s going on with somebody—I would try to figure out what situations they aren’t speaking in, try to find out if there’s some kind of common denominator, to ascertain whether there’s something in their background or their current context that would help explain what they are doing. You know, as in: Is it safe to speak? Is this, for example, a person of color going silent at times when racists might be present? Alternatively, is this a childhood sexual abuse survivor who is being triggered? Whatever it is, I would need to do that. But this is not what the DSM, as it were, prompts. In the DSM, “Selective Mutism” is a discrete disease. So, according to psychiatry, what causes these “symptoms” of not speaking? Well, “Selective Mutism” does. (Burstow, 2017, p. 33)
This introduces the problem of validity in the field of psychiatry, which usually applies biological claims in order to appear scientific. Szasz (1961) pointed out that illnesses as well as health conditions are referring to a body, thus a body or its organs can be ill or healthy. The mind, the psyche, is neither a body nor an organ. “[The mind, that is thinking and feeling] is rather an activity of the body much like running and jumping and, as such, it can no more have a disease than running or jumping” (Burstow, 2017, p. 32). Pharmaceutical discourses refer to mental illness as a chemical imbalance, which proves a brain disease. However, “according to the Virchow criterion (the medical gold standard), to qualify as a disease there must be real lesions, real cellular abnormality observable directly or by tests. … And note, chemical imbalances do not constitute lesions or cellular abnormality” (Burstow, 2017, p. 34). As Burstow shows, there is no chemical imbalance prior to pharmaceutical treatments, so even for people diagnosed with schizophrenia with an assumed dopamine imbalance, it was found that after the treatment with neuroleptics, they developed a prevalence of extra dopamine receptors, supporting the hypothesis that excess dopamine causes schizophrenia. In sum, the diagnoses listed in the major psychiatric diagnostic manuals have not yet been linked with any sort of physical test or other biological marker (apart from the dementias) and so, unlike the rest of medicine, psychiatric diagnoses do not have pathophysiological correlates and no independent data is available to the diagnostician to support their subjective assessment of diagnosis (Timimi, 2014). Even when not applying a strong antipsychiatry standpoint like Szasz, the biomedical model in mental health contains problematic pre-assumptions: mental health problems are located within an individual person, understood as being biological in nature or due to faulty cognitive or emotional processing. These faulty mechanisms are usually modelled in causal terms, described as universal principles regardless of their contexts (Bracken & Thomas, 2017).
The next section presents common psychological understandings of the concept of resilience and illustrates the associated shortcomings of dominant approaches in the psychological discipline. In the third part of this article, the Western neoliberal and goal-based view of human nature is overcome by focusing on contexts—that is, by considering political, economic, as well as cultural contexts. It highlights endeavours of critical psychologists and psychiatrists focusing on indigenous knowledges, structural inequalities, and embedded units of meanings and cultural practices (see, e.g., Cohen, 2017b). Only with this contextualized understanding of resilience, power differentials that account for an unequal distribution of health resources within our society become visible.
Common psychological understandings of resilience
Historically, the discipline of psychology analysed how strain and adversity lead to relevant clinical burdens in a person. For a long time, the primary psychosocial consequences of negative life events were viewed to be the harm and damage suffered by the individual. Generally speaking, an individual’s stressful life circumstances were considered only in terms of their potential to negatively affect that individual’s ability to function mentally, physically, and socially. Since the 1990s, there has been a gradual expansion in the perspective which focuses on the diversity of human responses to extreme stress. Prior to that development, this diversity was buried in trauma discourse, which, with the introduction of the posttraumatic stress disorder (PTSD) diagnosis to the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association, dominated the psychological research and practice of the time (see Bonanno, Brewin, Kaniasty, & La Greca, 2010).
PTSD is not necessarily accompanied by dysfunction: “People may experience distress and disease and yet remain committed and absorbed in their life tasks as parents, partners, workers, citizens, and friends” (Hobfoll, 2011, p. 128). Human beings typically encounter a variety of difficulties and challenges during the course of their lives, ranging from daily hassles to major life events. Typically, there is a considerable amount of diversity in the longitudinal trajectories of responses to stress (see Norris, Tracy, & Galea, 2009). Severe manifestations of problems are observed only in a small percentage of exposed individuals (Bonanno et al., 2010). Bonanno (2004) demonstrated the many different ways in which adaptive functioning can occur following strain. Under normal circumstances, major life events do not result in psychological and social collapse. In fact, they tend to yield a wide variety of trajectories, most of which are positive in nature. As a result, concepts such as resilience, resources, skills, and competence became increasingly important in the field of psychological functioning.
The turn to salutogenetic factors could include a hindrance to the profit accumulation in the new trade in lunacy described above. However, the neoliberal paradigm can also imply a commodification of mental health assets (see Timimi, 2017). Psychological resilience, the bouncing back from adversity, is linked with so-called protective factors such as hardiness (Bonanno, 2004), positive emotions (Tugade & Fredrickson, 2004), extraversion (Campbell-Sills, Cohan, & Stein, 2006), self-efficacy (Gu & Day, 2007), spirituality (Bogar & Hulse-Killacky, 2006), self-esteem (Kidd & Shahar, 2008), and positive affect (Zautra, Johnson, & Davis, 2005). Resilience consists of various factors that promote personal assets and protect individuals from the negative appraisal of stressors (Fletcher & Sarkar, 2013). Psychological resilience therefore is understood as the “ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event … to maintain relatively stable, healthy levels of psychological and physical functioning, as well as the capacity for generative experiences and positive emotions” (Bonanno, 2004, pp. 20–21). Most researchers concur that, for resilience to be demonstrated, both adversity and positive adaptation must be evident (Fletcher & Sarkar, 2013). The American Psychological Association considers resilience to be the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress such as family and relationship problems, serious health problems, or workplace and financial stressors. 1 Richardson (2002) and Richardson, Neiger, Jensen, and Kumpfer (1990) formulate a model, in which the resilience process begins with a state of bio-psycho-spiritual homeostasis, or a comfort zone, where a person is in balance physically, mentally, and spiritually. Disruption from this homeostatic state occurs if an individual has insufficient resources or protective factors to buffer him or her against stressors, adversities, or life events. In time, an individual who has experienced disruption will adjust and begin the reintegration process. The process is described with four outcomes: resilient reintegration (an individual attains additional protective factors and a new, higher level of homeostasis); homeostatic reintegration (a person remains in his or her comfort zone, in an effort to “just get past” the disruption); reintegration with loss (the individual loses protective factors resulting in a lower level of homeostasis); and dysfunctional reintegration (a person uses so-called destructive behaviours such as substance abuse in order to compensate for the losses).
In line with the neoliberal paradigm, public health focuses on how individuals can become resilient and maintain their resilience. Timimi (2017) uses the term “commodification” in order to describe a process by which goods, ideas, etc. are installed with a commercial value that can be sold and bought. Resilience and mental health may be considered as commodities in a neoliberal culture. Buying or having these things promises a better life. Cohen (2017a) shows how a neoliberal political economy managed to commodify subjective states, from disorders such as trauma, anxiety, or depression, to enhancing well-being, emotional intelligence, and self-esteem. According to him, people distance themselves from a more involved understanding of the problems they experience due to the process of commodification. Commodification helps to de-contextualize subjective experiences from their structural embeddedness, from economic and political as well as cultural frameworks. It disconnects people from the possibilities they already possess to deal with a problem (referring to constructive as well as destructive coping attempts). Commodification contributes to a hierarchical relationship between a “patient” and a psychiatric professional. At the same time, Timimi (2017) points out that commodification reinforces the idea that any perceived failure or suffering is the result of personal and internal factors, and that a professional is needed to help cure these internal dysfunctions. Above all, psychiatric praxis mostly still focuses on this impairment side, the pathogen path instead of applying a contextualized salutogenetic standpoint.
By categorizing states of emotional and behavioural difference and deviance as vulnerable, as dysfunctional, as disordered in contrast to mental health and resilience, and when this categorizing occurs in a free market context, these categories enter the market as well and become brands (see Timimi, 2014). The brands of disorders develop a market including a variety of products and services: professionals with expertise in that brand and who apply certain techniques such as a particular medication or psychotherapy, books, courses, and so on. In a neoliberal logic, commodities tend to give only temporary experiences of satisfaction, markets need to keep selling, need to keep the monetary flow going. Therefore, concepts such as resilience offer a desire to convince consumers that there is a better product available or if they stop consuming a brand, their life may deteriorate. In this neoliberal logic, the number of available psychiatric diagnoses and specified treatments for these specific disorders need to expand. Our consumer culture helps to produce mental stress, and this distress is turned into a growing market of exploitation and profit (see Timimi, 2014).
Psychological definitions of resilience presented so far show that mainstream psychologies historically focused on the individual level, neglecting the socio-political contexts people live in. Access to and control over health-influencing resources such as education as well as economic assets such as work, credit, etc. was not explicitly considered in the concept of resilience. With a tendency to focus on the individual level, person-centred intervention strategies are dominant. The American Psychological Association for example recommends the following strategies for resilience: “Avoid seeing crises as insurmountable problems. … Accept that change is a part of living. … Move towards your goals. … Take decisive actions. … Look for opportunities for self-discovery. … Nurture a positive view of yourself” (APA, 2018). This demonstrates the Western neoliberal and goal-based view of human nature which understands human beings’ basic motivation as moving toward goals while avoiding threats. It lies within the responsibility of the individual to take on an attitude and behave in ways that are influential and lead to satisfactory performance. It links with Western over-emphasis on person-centred constructs and on a goal-based human nature linked to ideas of self-regulation, conscious control over agency, and rational calculation. In Europe, an autonomous, independent self that aims at individual enhancements and the conquest of new domains is highly valued. The person is considered to be in charge of his or her life course, and intentions are emphasized (Carver & Connor-Smith, 2010; Morling & Fiske, 1999).
The need for contextualized understandings of resilience
The idea of the individual as the locus of the self creates the psychological pre-conditions necessary for accepting the “atomized” and decontextualized social worlds that have been created in this neoliberal world. As a form of mental health colonialism, this goes hand in hand with the last few decades, during which Western mental health institutions have been pushing the idea of “mental-health literacy” on the rest of the world, according to Timimi (2014). This implies the assumption of universally applicable labels of mental illness or health. We export disease categories and risk to replace indigenous ways of coping with life hassles, thus opening up a lucrative new market for Western drug companies and psychotherapies. Furthermore, we risk imposing discriminatory praxes in a neo-colonial way if we do not contextualize our understandings of resilience and vulnerability: As the criteria for diagnoses are arrived at by subjective judgments rather than objective evidence (being literally voted in or out of existence by committees), they will have an automatic bias toward the cultural standards found in economically dominant societies (who also tend to control what counts as “knowledge” globally). This sets in motion a diagnostic system vulnerable to institutional racism in the dominant societies and colonialism in others, as other standards of normality will, at least to some extent, come to be viewed as “primitive,” “superstitious,” etc., and their populations will be viewed as needing to be (psycho)educated. (Timimi, 2014, p. 212)
In the view of sociological systems theory, the construction of the semiotic reality is realized by observation: defined as an operation of distinction and designation (Luhmann, 1994). In the context of health and illness―or of resilience and vulnerability, it is usually professionals who make a distinction of what is regarded as “normal”: Health [or resilience], therefore, is a constantly renewed construction, realised by different observers (e.g., individuals or health professionals) and influenced by their cultural context or the time they live in. The observation of health [or resilience] can focus either on the health side or on the health-impairment side of the continuum. (Hafen, 2016, p. 438)
As described above, from a Marxist viewpoint, the mental health system defines acceptable behaviour by naming and specifying what is “crazy.” According to Cohen (2017a), with the development of neoliberalism the mental health system evolved into an institution of civil society with a potential to impart hegemonic ideology: “Hegemonic power is conducted under the guise of objective and neutral institutional practice, though it is in reality nothing of that sort” (Cohen, 2017a, p. 51). Mental disorders and concepts such as resilience or vulnerability appear to be natural and represent a taken-for-granted knowledge. According to Timimi (2017), this process is called scientism and refers to an inappropriate use of science. Mental health workers claim to apply scientific arguments and practices because they “do” science and rather not because relevant evidence-based findings are available. A very high value is placed on natural science, the empirical science constituting an authoritative worldview: In order to gain a market in a culture where the cosmology uses a narrative of science for authoritative positioning, using the language of “science” is more valuable than the actual research findings if what is discovered is unhelpful for selling the product. (p. 60)
The mental health system uses the narrative of scientism with concepts such as evidence-based treatments (pharmaceutical and psychotherapeutic), of resilience and vulnerability, alongside the neoliberal narrative of advancement in health associated with technology and scientific progress offering hope. The use of brain scans and research on genetics fits into that image of scientific psychological technology. This scientism helped to conceal the fact that empirical evidence for psychotherapeutic and pharmaceutical technologies is no better than placebo treatments, especially in the long-term (see Timimi, 2014).
Mental health and concepts such as resilience are not ontological facts but contain the moral codes of a current society. One example is the pathologizing of grief: in the Diagnostic and Statistical Manual or DSM-IV, a person in grief could be diagnosed with a major depression after two months, whereas in the DSM-V, this period was shortened to two weeks (Bandini, 2015). Phenomena formerly described as mental disorders like homosexuality are socially accepted at large today and not regarded as a health problem anymore (transsexuality, however, is still a diagnostic entity). And even though the DSM finally removed homosexuality as a mental disorder, that is homosexual people moved towards “normality,” the binaries underlying dominant psychological discourses continue to exist (Diamond, 2017). With homosexual identity being normalized, the resistance strategies of homosexual people against homophobia continue to be pathologized as mental disorders, such as anxiety disorder, bipolar disorder, etc. The strategies for surviving are decontextualized and individualized as mental disorders.
The social-constructive nature of psychological constructs does not imply that material and intersubjective contexts do not matter in coping processes. Mental wellbeing or resilience both seem to be closely connected to social and economic factors. Several international studies have concluded that the greater the inequality (in economic and social resources) in any society, the poorer the mental health or resilience of that society (Pickett, James, & Wilkinson, 2006; Pickett & Wilkinson, 2010). Hatch and Dohrenwend (2007) examined the distribution of stressful or traumatic life events as dependents of demographic variables such as ethnicity, socioeconomic status, gender, and age in a review of literature from 1967 to 2005. The authors illustrate how a context-oriented understanding of resilience and resources can be implemented in research. They close their review with the following conclusion: groups with a low socio-economic background, ethnic minorities, and young people are increasingly exposed to traumatic and stressful events with corresponding health trajectories. According to a life course perspective, cumulative inequality interacts with one’s ability to mobilize social, economic, and psychological resources, together with human agency (i.e., the ability to change one’s environment), in shaping the individual’s mode and level of functioning throughout the course of life (Ferraro & Shippee, 2009).
Another promising approach is presented by Hobfoll and colleagues’ (Hobfoll, 2001, 2011; Hobfoll & Buchwald, 2004; Hobfoll, Hall, Horsey, & Lamoureux, 2011) theory that focuses on the objective elements of threat, loss, and common appraisals rather than subjective idiographic appraisals. The theory is based on the premise that human beings will strive for resource gains; that is, for things they value most highly. Value is attributed to resources based on the specific cultural context. Resources include objects such as a car and a house, conditions such as being employed and being married, as well as personal resources such as skills (Hobfoll, 2011). Hobfoll (1998) states that the availability of social support is dependent upon power and status. According to him, certain people are nested in settings which offer them rank and privilege. Those lacking in status and power suffer social discrimination almost independently of their own behaviour. However, those with power, status, and privilege are faced with developmental conditions—Hobfoll refers to these as “caravan passageways” (2011, p. 129)—which lead to social inclusion.
Applying a contextualized understanding of resilience translates into the acknowledgement that the access to and the control over health resources affect habitus, lifestyles, as well as health behaviour throughout the lifespan. Therefore, resilience should be considered as a product of cultural, social, economic, political, and psychological factors, as well as its biological correlates, above all as a product of structurally embedded social inequalities along dimensions of gender, socioeconomic status, ethnicity, etc. (see Schwarz, 2013, for intersectional approaches within psychology). Resilience is not only linked to the fulfilment of societal notions of normality but with the ability for self-determined participation in public and private life, the labour market, profit-sharing, and the capacity for well-being, among other things. Resilience is associated with the opportunity for well-balanced living within one’s social surroundings and with the possibility for living in line with one’s spiritual and worldly beliefs, without having to fear discrimination. Therefore, understandings of resilience should be linked with human rights and political as well as socioeconomic dimensions of life (see also the critical community psychology approach formulated by Kagan, Burton, Duckett, Lawthom, & Siddiquee, 2011).
In the psychotherapeutic setting, a contextualized understanding translates into the reconstruction of the development and maintenance of illness and resilience that is not confined to individual factors but rather one that focuses on the structural embeddedness of individuals within their contexts. It calls for policy interventions alongside person-centred counselling. In cases of political violence and related traumatization, this contextualized and human rights approach is more acknowledged compared to the general field of mental health that tends to emphasize biomedical solutions. For example, narrative exposure therapy (NET) is a treatment approach that is based on both the cognitive behavioural treatment of PTSD and testimony therapy (Cienfuegos & Monelli, 1983). There is evidence that NET is associated with significant reductions in PTSD symptom severity (see Robjant & Fazel, 2010, for a review).
Even though the current diagnostic systems used in psychiatry, like the DSM, have arguably failed to establish themselves as scientifically credible and clinically useful, patients are influenced by the neoliberal culture we live in, having internalized the hegemonic discourse: Pressures to compete and then deal with perceiving oneself (or being perceived by others) as a “loser,” the individualization of identity and ambition, the internalization of anxieties of failing, … and the commodification of potential solutions (such as through the offer of pharmacological and psychological therapies) all contribute to the rapid growth in numbers of psychiatric diagnoses …, and the increasing prevalence of services and products for these diagnoses. (Timimi, 2017, p. 61)
As a consequence, our mental health system should abandon designing services around diagnostic concepts. A contextual understanding of resilience may better serve the purpose of helping those in need from a critical background. Outcome-oriented research, including the perspectives of service users, may better inform how to design appropriate mental health services in the future, as Timimi (2017) points out. However, the problem remains that those living in a neoliberal society may expect the delivery of an easy to consume commodity to solve whatever the difficulty they perceive they are experiencing. The pharmaceutical industry is successfully promoting this medicalization of mental suffering. Therefore, therapists need to answer a dilemma cautiously, a dilemma between over-critically questioning and passively accepting the neoliberal discourse which may expose the patient to unnecessary harm. Mental health professionals should avoid falling into the “trap of promoting the vicious neoliberal system by passively accepting the roles handed out to us of commodity peddlers, increasing the market share for a corrupting McDonaldised and pharmaceuticalized mental health industry” (Timimi, 2017, p. 62). What matters in psychotherapy is the quality of relationship between client and therapist, that the service user feels respected and valued, that the encounter is meaningful, and not so much what model and what specific technique was applied (Cooper, 2008). The therapeutic context should create a respectful, hopeful, and democratic environment, as Warner (2003) points out in line with the recovery movement.
When applying a contextualized understanding, resilience exists not only on an individual level, but also refers to the level of interactions, of communities, and larger social entities such as regions and states. It goes beyond the psychotherapeutic room and calls for communal interventions and (inter)national policies. It exceeds common social support approaches that are already acknowledged in the field of resilience (Schwarzer & Knoll, 2007). It includes analytical levels broader than the individual and accounts for local peculiarities. Kirmayer, Dandeneau, Marshall, Phillips, and Williamson (2011), for example, apply a narrative approach to resilience. This allows for a contextual and cultural sensitivity that includes historical dynamics of oppression and colonialization as well as broader social dimensions while still allowing for biographical and thus unique differences. Zaumseil, Schwarz, von Vacano, Prawitasari-Hadiyono, and Sullivan (2013) exemplify a contextualized approach in an Indonesian earthquake district. They highlight local virtues and values as well as a transcendental or spiritual interconnectedness with the cosmos and nature.
Communities exist in an ecological balance with their surrounding environment. They require a moral economy regulated by ideas about coexistence. For indigenous peoples, this has been traditionally conveyed through stories that are built around culturally informed notions of personhood that link the individual to the community (both past and present) and to the land and environment. (Kirmayer et al., 2011, p. 89)
Forgiveness, peace, friendship, mutual support, and reciprocity in general were identified on a cultural and communal level against the background of a colonial history with exploitation and oppression. According to Kirmayer et al. (2011), communities strengthen resilience through political activism and empowerment. If active engagement is successful, this not only brings material gains but enhances the collective as well as individual self-esteem, which in turn is associated with better communal as well as person-centred mental health (Chandler & Lalonde, 2008).
Concluding remarks
Neoliberalism promotes creativity, independence, motivation, rationality (choice), excellence, enrichment, and fulfilment. This is in line with the rise of positive psychology and related concepts such as resilience. At the same time, mental disorders are on the rise and neoliberal capitalism promotes an authoritarian control over people, fatalism, conformity, apathy, mystification, social ignorance, self-ignorance, anxiety, helplessness, and depression (see Ratner, 2015).
If psychology and psychological constructs remain apolitical, this not only privileges established social structures, which are often shaped by unequal power relations and injustice (Harvey, 1996; Swyngedouw & Heynen, 2003), but also closes off wider questions of progressive social change which require interference with, and transformation of, established systems. In fact, the majority of psychological literature is individualistic, White, Western, control-centred, and ignores power differentials and the role of oppression. It is further embedded within an elitist set of assumptions that people have the resources to come to treatment, that there are ample providers to administer such treatment, and that, if successfully treated, their core problems will be diminished (de Jong, 2002; Hobfoll, 2013). This article aimed for a contextualized understanding of resilience that may overcome this ethnocentric and neoliberal bias in many Western psychologies.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
