Evaluating resilience factors in the face of traumatic events in Kuwait MEDICAL SCIENCES (2000), 2, 111−116 © 2000 SULTAN QABOOS UNIVERSITY 1Department of Sociology and Social Work Kuwait University, Safat, Kuwait 13150. Email: alnaser@qualitynet.net 2Tri County Trauma and Education, 702 Park Way, Santa Cruz, CA. 95065-1326. Email: :tattoo@ix.netcom.com *To whom correspondence should be addressed. 111 Evaluating resilience factors in the face of traumatic events in Kuwait *Al-Naser F1, Sandman M2 األحداث مواجهة في المرونة عوامل تقييم الكويت دولة في الصدمية ساندمان مارك الناصر، فهد . سنة الكويت دولةل العراقي الجتياح ا آلثار نتيجة الحالي الكويتي المجتمع في ةللمرون الشخصية السمات على التعرف الى البحث يهدف :الهدف: ألملخص من495 من مكونة الكويت جامعة طالب من من عينة على وزع سؤاال 14 من يتكون مقياس وهو )89ER (الذاتية المرونة مقياس طبق:لطريقةا1990 ،والمستوى األجتماعية والمكانة-األسرة ،ونمط التعليم للجنس،والعمر،ونوع تبعا مجموعات الى بالطال قسم ،وقد فأآثر سنة 17 أعمارهم واألناث،تبلغ الذآور المطلقة المتغيرات تجاه الثانوية للمتغيرات األحصائي التحليل وتقييم المرونة لتحديد للنقاط تبعا المتغيرات تلك تأثير لتقييم وذلك األجتماعية والحالة التعليمي، :آالتالي النتائج وجاءت الجنس مقابل في األسرة ونمط واألناث للذآور للمرونة العالية واألنماط باألساليب المقارنة مع تزامنا المجموعات تلفمخ في المستقلة على ممتدة أسر من الطالب حصل وقد األناث من أعلى نقاط على الذآور حصل وقد عالية مرونة وذو بأنهم صنفوا العينة أفراد من%) 37 (الثلث من أآثر أن اًًفروق ظهرت الدراسة أ:الخالصة. اآلداب آليات طالب من أعلى نقاط على حصلوا العلمية الكليات طالب أن آما نووية، أسر من عليه حصل ممن أعلى نقاط لبحث اساسا الدراسة تكون قد .األناث من ءللشفا أآبر امكانية الذآورعلى حصل آما واألناث الذآور الكويتيين الطالب بين نة المرو في احصائية داللة ذات .العربي الخليج منطقة في العربية الشعوب لدى المرونة ونوعية ومقدرة قوة لقياس مستقبلي ABSTRACT: Objective – To identify the personality characteristics of resilience in contemporary Kuwaiti society, in the aftermath of Iraqi invasion of the State of Kuwait during 1990. Method – Ego Resiliency Scale (ER89), a 14-item self-report inventory scale with a maximum score of 56, was administered to a sample of 495 male and female students of Kuwait University, aged 17 and above. Students were also grouped according to gender, age, type of education, family type, social status, educational bent, and marital status to assess the effect of these variables in their resilience scores. Results – Over one-third (37%) of valid subjects qualified as highly resilient, with the males scoring higher than scores than the females. Students from extended families scored higher than those from nuclear families. Science students had higher resilience scores than arts students. Conclusion – There is significant resilience and adaptability among Kuwaitis, with males scoring higher than females. This study could serve as a baseline for future inquiry into strength and resilience qualities of the Arab population in the Arabian Gulf region. KEY WORDS: Kuwait, personality, resilience, Arab, Ego, ER89. ans Selye, the noted international authority on stress and author of the first published scientific paper on stress in 1936 stated, ‘It is not what happens to you that matters, but how you take it’.1 In the face of traumatic events, people cope and adapt in varied ways and show varying degrees of resilience. Investiga- tion into the qualities of personality resilience form the basis of this study, which seeks to identify the personality characteristics of resilience in contemporary Kuwaiti so- ciety, in the aftermath of invasion of the State of Kuwait by Iraqi army on August 2, 1990. The random and arbitrary violence inflicted by the invaders resulted in many Kuwaitis becoming affected by post-traumatic stress disorder (PTSD). Families were separated, in some cases, permanently. Kuwaiti families had to draw heavily from their emotional resources of courage, stability and durability. The frustration and anxi- ety persisted even after the liberation. Many found they lacked the motivation to work; few were able to sleep well. Kuwaiti children remained fearful and anxious and parents became over-protective. A great deal of the inva- sion related trauma experiences for Kuwaiti families ap- pear to be connected to family separations, some of them permanent. The feelings of deep insecurity caused by these appear to have had a lasting impact on family read- justment. Yet, it was the family that played a pivotal role in the process of recovery and served as a gauge of the H A L - N A S E R & S A N D M A N 112 cultural durability that allowed many Kuwaitis to survive the horrors of the invasion. Individual differences in per- sonality also contributed to the differences in the degree of recovery. These were the factors that the present study investigated. Several Western studies that focused on such quali- ties in human personality as strength and resilience, cov- ering psychological, social and physiological domains, have direct bearing upon the present study. In some of these studies, ego resilience has been primarily examined within the context of coping with extreme adversity,2,3 while others have focused on specific personality do- mains or attributes.5 Over the last decade, the term resil- ience has come into increasing use, most notably focusing on stress resistance.6–8 More recently, attempts have been made to understand the protective processes underlying resilience.8–9 Block7 identified the role of ego control and ego re- silience in the organization of behaviour and found strong connections between ego resilience and effective functioning in diverse areas of life. Subsequently, many studies clearly identified ego resilience in several contexts. For example, several studies10–13 sought to define the concept of ego resilience as a particular theory depend- ent one, and sought to express some useful recognition achieved by psychodynamic theory as well as to generate explicit behavioural predictions. In the recent years however, the trend has been for using the term resilience without the prefix of ego, thus making it less formal, simpler, although a descriptive term. Still other researchers14–17 use resilience to describe invulnerable individuals and survivors, identifying indi- vidual characteristics of successful adaptation, despite seemingly significant challenges or threats to that adapta- tion.18 Other notable research19 endorses the encompass- ing possibilities of the Ego Resiliency Scale 89 (ER89).11 In general, ego resilience can be evaluated in different ways including in laboratory situations, prolonged contex- tual evaluations of individuals in their daily lives and by using a specifically constructed self-report questionnaire scale such as the ER89. The ER89 is a brief inventory scale, with a relatively high reliability. However, although several personality studies have been conducted in the Arab world, we have been unable to locate any previous study that used the ER89 Scale to specifically identify resilience. This work then, must be viewed as a base line study for this part of the world. METHOD The present study used the latest version of the ER89 scale, which is based on several previous samples entirely different from this one. A major advantage of the ER89 Scale is its simplicity, which enabled an accurate and reliable translation from English to Arabic and vice versa, thereby minimising the potential for cultural mis- understandings. Secondly, the fact that ER89 evolved over many years in various studies of non-psychiatric populations12 has given it proven reliability. The scale attempts to measure the quality of resil- ience by assessing the way each person manages the fluc- tuations in daily life and what they do about their own experiences. While those scoring higher in the scale are not necessarily free of emotional distress and impair- ment, emotional problems would be expected to be much more prevalent among those ranked lower. TABLE 1 Ego Resiliency Scale 89 [ER89] # 1. I am generous with my friends. # 2. I quickly get over and recover from being startled. # 3. I enjoy dealing with new and unusual situations. # 4. I usually succeed in making a favourable impression on people. # 5. I enjoy trying new foods I have never tasted before. # 6. I am regarded as a very energetic person. # 7. I like different paths to familiar places. # 8. I am more curious than most people. # 9. Most of the people I meet are likeable. # 10. I usually think carefully about something before acting. # 11. I like to do new and different things. # 12. My daily life is full of things that keep me interested. # 13. I would be willing to describe myself as a "pretty strong personality". # 14. I get over my anger at someone reasonably quick. The study randomly selected 500 students (250 male, 250 female) of ages 17 and above, enrolled in the two colleges of arts and science of Kuwait University (only 495 responses were used). The 14-item self-report inven- tory scale (Table 1), a simple and accurate way of re- cording the ‘pure qualities of resilience’ was administered to the students. Added to the original ER89 scale were questions on age, social status, education, intended to reveal social and personal characteristics. Each of the 14 items in the questionnaire required response on the following 4-point scale: 1 = does not apply at all 2 = applies slightly, if at all 3 = applies somewhat 4 = applies very strongly. R E S I L I E N C E I N K U W A I T I S 113 A response of 4 represents a high ranking on the ER89 Scale. The maximum score is 14 × 4 = 56 and the minimum 14 × 1 = 14. The top of the scale suggests a person with energy and excitement for life, curious, se- cure, with ability to recover quickly from life’s stresses and one who is likable and likes others. Using data from the ER89 Scale (Table 1) the initial ‘split’ was made using the tertile deviation method instead of a mean split, shown in Table 2. We aimed to evaluate the dependent variables against the independent variables in various combinations to compare the high resilience styles of male/female and gender versus family style. There were one or more miss- ing values for those dependent variables in approximately 10% of the subjects, leaving us with 447 valid subjects of the original 495. The 447 subjects were divided equally into 3 groups 149 each. The groups were split based on a ‘frequency distribution’, and it was determined that the lowest one-third had a range of scores from 20–38 (based on the sum of all 14 dependent variables). The number in this ‘Low Group’ (LG) was 152, coming close to our target of 149. The High Group (HG1) did not seem to come out as clean. When a range was used from 43–55, (the highest score) the number of subjects in this group was 164. When a range was used from 44–55 the number of subjects was 134 High Group 2 (HG2). By choosing a scoring range that differed by 1 point 30 subjects were included or excluded. Finally, in order to test for significant differences in the different permuta- tions of grouping variables, two types of analyses were run: T-tests and Analysis of Variance (ANOVA). The T- tests were used to evaluate groups of two categories: gender, college type, family structure, and marital status. ANOVA was used to evaluate groups of two or more categories. TABLE 2 Grouping using Tertile Deviation Method Statistics All groups Low Group (LG) High Group 1 (HG1) High Group 2 (HG2) Count 447 152 164 134 Mean 40.6 34.7 49 46.6 Maximum 55 38 55 55 Minimum 20 20 43 44 Sum 18144 5279 7537 6247 Variance 29 11.8 6.6 5.7 Standard 5.4 3.4 2.6 2.4 Note: A few respondents did not fit into a particular category that would have classified them within the LG, HG1 or HG2 since they fell outside the variables required to place them into one of these three groups. Therefore, the total number of the LG, HG1 and HG2 on the count line do not total 447. RESULTS Based on the tertile grouping method and using the HG1 results, over one-third (37%) of valid subjects (447) qualified as highly resilient. The respondents were then grouped by gender, age, type of education, family type (nuclear, extended) social status, educational bent, and marital status, to assess whether the various groups’ resil- ience scores differed significantly. The only groupings that produced significant results were, respectively, gen- der, family type, and college affiliation. Gender: Males (41.15%) had significantly higher resilience scores than females (39.66%) and (t = 3.10, p = 0.002) in the study. Family type: Extended families (41.34) exhibited higher resilience scores than nuclear families (40.04) and (t= – 2.61, p = 0.009). College affiliation: College of Science stu- dents (41.06) had higher resilience scores than those stu- dents enrolled in the College of Arts (39.95) (t = –2.11, p = 0.038) (Tables 3 and 4). DISCUSSION As indicated earlier, higher scores (above 43) suggest above-average resilience qualities. Such a person could be expected to possess a secure personality with energy, en- thusiasm curiosity, ability to recover from stress, liking company of others and generous. As we expected, gen- der roles were important in the results; high female scores tended to indicate a person who was independent, flexi- ble, and personally satisfied. High scoring males sug- gested someone who had warm relationships, who was ethical and responsible, with the ability to temper any feelings of hostility and antisocial destructive behaviours associated with low self-esteem and low self-confidence. The interpersonal achievement of control and re- duced aggression is not highly associated with resilience in Kuwaiti women, possessing lower levels of aggression. High scoring Kuwaiti women would be expected to be independent, skilful in interpersonal relations, and not submissive. A high scoring male would be ethical, respon- sible in behaviour, conservative, predictable, consistent and able to accept societal limitations,18 while a high scor- ing female can be characterized as assertive with the abil- ity to express feelings directly and a high regard for themselves, social poise and presence, while playful and without fear of recrimination. The resilient Kuwaiti male scoring high can express his feeling directly, is cheerful and protective and has the capacity for warmth and inti- macy while remaining relatively free of interpersonal hos- tility and mistrust. The members of nuclear families and those who have come from extended family situations are significantly notable because of the current transitions of modern Kuwait society with respect to how the shifting family styles of the Kuwaiti people has evolved. It is known that different type of socialization pres- sures experienced by girls can affect the form, style and A L - N A S E R & S A N D M A N 114 knowledge as to their ability to negotiate through the world of interpersonal relations.13 Kuwaiti men develop structures that help to modulate aggression, in turn help- ing to ensure a more successful socialization. There are sources of resilience that lie in Kuwaiti society that have helped to support a survivability under duress, perhaps demonstrating an individual and cultural ability to thrive during misfortunes. A clear example of this unity and personality can be seen in the Diwaniya in Kuwait, which has historically played a prominent role in a society where family, tribal roots and friendship are highly valued. Diwaniyas are informal gatherings of non- association groups, and fall into the same general cate- gory as tribes and families. They are unregulated and in- formal, highly fluid and somewhat hidden, although not secretive, and rely on personal interactional patterns of communication. Diwaniyas are highly influential and in- formal meetings with friends, family members and others included, representing all socio-economic levels of soci- ety. Diwaniyas function within the extended family net- works, creating bonds of trust and loyalty. The socialization process in Kuwait is an important part of personality resilience and is perhaps partially ex- plained by the different roles prescribed by traditional Kuwaiti society, its institutions, customs, and normative scripts. The Arab culture has been considered throughout its history more as a collectivist culture, where a person’s identity is based more on the social system with greater dependence on their institutions and organizations. The influence of these organizations in turn helps provide order and security to individuals. The strength and resilience of Kuwaiti personality could not be mentioned without including references to family and their personality qualities, as well. The tradi- tional extended family has been predominantly associated with less than modern societies, especially those in which business and industry are viewed as less important than agriculture.21 Historically, family life for early Kuwaitis was very stable and consistent. Beginning in ancient times, from which historical records are extant, to the present day, Arab Gulf families have appeared to remain the same, made up largely of the same personnel, structured along the same lines, fulfilling the same functions and commanding the same loyalties from its members.21 The dignity of women was guarded through veiling and seclu- sion. Family commitment was so deep and complete that divorce was not considered to be a viable option and not an easy thing to come by. Marriage was a social and eco- nomic agreement between families. Early Kuwaitis prized and valued the importance of the extended family, and during hard times or crisis, the extended family would come together to provide emotional and psychological support and encouragement for each other. Marriages usually occurred at a very young age for women and at an older age for the men. Family members were very de- pendent on each other for their economic survival, mainly functioning as an economic, social and psycho- TABLE 3 T- Test Results Groups Resilience SD t-value p-value Gender 2.55 0.011 Male (256) 41.15 5.47 5.19 Female (191) 39.84 5.19 College –1.86 –0.064 Arts (198) 40.02 5.41 Science (201) 41.03 5.55 Family structure (total) –1.8 0.072 Nuclear (256) 40.22 5.53 Extended (176) 41.17 5.18 Family structure (male) 0.15 0.884 Nuclear (130) 41.26 5.57 Extended (119) 41.26 5.46 Family structure (female) –2.53 0.12 Nuclear (126) 39.14 5.29 Extended (57) 41.19 4.6 Marital status (total) –0.03 0.975 Single (331) 40.58 5.31 Married (113) 40.6 5.58 Marital status (male) –0.55 0.584 Single (178) 41.03 5.41 Married (75) 41.44 5.56 Marital status (female) 1.19 0.236 Single (153) 40.07 5.15 Married (38) 38.95 5.33 TABLE 4 Analysis of Variance (ANOVA) results Groups Resilience SD t-value p-value Education 1.39 0.200 First year (80) 41.34 5.82 Second year (137) 40.58 5.53 Third year (95) 39.71 5.17 Fourth year (127) 40.74 5.19 Age (total) 0.75 0.474 17–20 years (149) 40.49 5.59 21–24 years (235) 40.46 5.23 25 and above (58) 41.4 5.37 Age (male) 0.18 0.830 17–20 years (51) 41.39 6.16 21–24 years (146) 41.46 5.44 25 and above (56) 41.46 5.44 Age (female) 0.19 0.820 17–20 years (98) 40.02 5.24 21–24 years (89) 39.56 5.04 25 and above (2) 39.53 0.54 R E S I L I E N C E I N K U W A I T I S 115 logical unit. A son could usually look forward to taking on the role of head of the family business and inheriting the family land. The family would provide the education and would regulate the marriages. Of late, however, the Kuwaiti society has been un- dergoing tremendous pressure from social changes result- ing from the effects of urbanization, education and the war with Iraq. The rapid pace of this change has im- pacted most specifically upon the family. The traditional son/daughter now grows up in a society that values pa- triotism and career development. Emancipation of women is another powerful force directing the current course of the Kuwaiti society. Even though marriages are still arranged, sons and daughters are now consulted. While men follow the tradi- tion of marrying relatively late in life, women, who once married very young, are now older when they marry. The traditional practice and preference to marry within the family has declined, and a slow, noticeable shift in where the couples choose to live after marriage has been ob- served. The main psychological ties that bind families together have remained alive even though enormous so- cial changes have occurred through the years. Decision- making is also done in a more cooperative manner involving both husband and wife. As a result, the divorce rate and the practice of polygamy have declined. Kuwaiti citizens now exercise their own personal choice in select- ing a marriage partner resulting from physical attraction and love.22 In short, despite traditions remaining strong, a measure of social change has occurred, with social strati- fication becoming less determined by family origin and tribal affiliation and more by personal achievement and other tangible forms of success. Our study revealed that the added responsibilities of Kuwaiti married life have created a stronger, flexible person who is accommodative of change. CONCLUSION After a review of available historical records, we have perhaps found the origin of the contemporary resil- ient Kuwaiti personality. Because there were no scientific studies done in early Kuwaiti history, we felt compelled to rely upon the use of available archival records in an at- tempt to construct the basic ingredients of the early Ku- waiti personality. We decided the most accurate method of obtaining this information would be through the use of the socio-historical perspective. Prior to the discovery of oil, Kuwaitis led rugged lives, characterised by scarcity and hard work. The first guiding principles for Kuwaiti life were based on the belief in simplicity, spontaneity and social cohesion. We discovered that the early Kuwaiti per- sonality consisted of included components of what we now call a resilient personality or resilience. This study helped identify some of the underlying qualities that characterize the Kuwaiti resilience and adaptability. Our results have yielded a reliable representa- tion of the long-term structural nature of pure resilience in the Kuwaiti population. Referring to the ER89 scores, 67.6% of the answers fell into the ‘applies somewhat’ and ‘applies strongly’ categories of the scale, indicating strong resilience qualities. However it is not possible at this stage to draw concrete conclusions as to how those involved in this study compare to other peoples in the Arabian Gulf region. We believe that this study does, however, demon- strate certain unique aspects of the Kuwaiti people. Therefore, the scope of this study did not include the adaptation of the subjects to the invasion experience. 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