The Seamen’s Church Institute (SCI) has prioritized developing a cohesive assessment and treatment approach for seafarers susceptible to pirate attacks and accompanying trauma. Maritime piracy represents the single greatest risk to the seafaring community—not because of its prevalence, but because of the potential magnitude of traumatic experience. On January 25, 2013, I presented to the Mount Sinai Hospital World Trade Center Health Program on the issue of fostering resilience—both generally and among those affected by trauma. I presented two complementary approaches to thinking of resilience: as a trait and as a process.
Resilience describes how we get through the stressors of everyday life, how we survive tragedy and how we recover from traumatic experience. If we think of traumatic experiences as those that interrupt our ability to think, disturb our feelings and make us feel overwhelmed, resilience is the counterforce that minimizes the impact of trauma.
As a trait, resilience allows a person to maintain equilibrium in the face of potentially traumatizing experience, to adapt to change and to cope with and recover from disasters. As a process, resilience is possible at the individual and community level. An individual can be supported in coping, in using available help from loved ones and professionals and in returning to purpose in life. At the communal level, groups can bond around troubles affecting the whole group or members within it. This happens when a group accepts a person’s temporary weakness due to difficult experience by fostering an environment that does not pathologize suffering, but rather sees expressions of pain as opportunities to render help.
Current research investigates assessment measures and psychotherapeutic approaches to enhancing resilience as well as neuroscientific models to explain resilience in the brain (cf. the work of Dennis S. Charney at Mount Sinai). At present, few standardized assessments exist, though one that has had limited success is the Connor-Davidson Resilience Scale (CD-RISC, 2003), a 25-item self-report that determines whether resilience is increasing or decreasing in an individual over time.
During my presentation, I also discussed different therapeutic techniques. Psychotherapy and neuroscience research point to the potential risk of using grief-counseling models indiscriminately. Sometimes the instinctual helping response is useful and sometimes not. I highlighted one approach, Complicated Grief Treatment (Shear et al.), as a good compromise of grief counseling and an approach mindful of research on limiting the extent of trauma. Making good use of available resources is a key ingredient in improving seafarer mental health. Many seafarers come from supportive families and communities, and the literature on resilience and surviving traumatic experience suggests that acceptance by peers improves outcomes.
Extensive trauma, both in terms of length and intensity, especially tests resilience. Where there are direct threats to life, outcomes tend to be worse. The more the maritime industry and the international mental health community can accomplish in coordinating efforts to enhance resilience, identify resources and improve access to those resources, the less likely that most seafarers will suffer long-term effects of trauma.