Chapter 20

The Discourses of Resilience, ‘Enculturation’ and Identity in Aboriginal Mental Health Research

Tara L. Holton, Gregory M. Brass, & Laurence J. Kirmayer Sir Mortimer B. Davis–Jewish General Hospital & McGill University, Canada

SUMMARY

Resilience, a construct connoting the ability to adjust positively or recover easily in the face of adversity, is increasingly applied to mental health research and practice regarding Aboriginal populations. This research seeks to identify protective factors involved in resilience, as well as how such factors contribute to an individual’s positive adaptation. While the concept of resilience has received a variety of criticisms in the general literature in recent years (Luthar, Cicchetti, & Becker, 2000), there has been little critique of the construct as it is applied to Aboriginal populations. As part of a larger project examining concepts of resilience among indigenous peoples, this paper focuses on the use of the concept of ‘enculturation’, in recent literature on resilience among Aboriginal populations. The view of culture implicit in the concept of enculturation is at odds with current anthropological thinking and has specific implications for thinking about the role of identity in the challenging situations faced by many indigenous peoples.

DISCOURSES OF RESILIENCE

Over the last 30 years, the concept of resilience in psychology and psychiatry has undergone significant changes in how it is defined and employed in research and clinical literature. At present, resilience is generally understood to indicate the ability to adjust positively or recover easily in the face of adversity (Luthar, Cicchetti, & Becker, 2000). When the concept originated in the 1970s, some researchers who studied children facing developmental difficulties labeled those who thrived despite high risk as ‘invulnerable’ (Anthony, 1974; Garmezy, 1971). Resilience was understood to be an unusual characteristic, displayed by exceptional children who, despite severe adversity, developed into normal and healthy individuals (Masten, 2001). Invulnerability was seen as a testament to an individual’s constitution. The vulnerable child was likened to a doll made of glass or brittle plastic, which could crack, fracture or shatter easily, while the invulnerable child was like a doll made of steel, not easily dented or damaged (Anthony & Cohler, 1987). Although environmental factors were seen as protective, the child was seen as having an unchanging constitution and resilience, therefore, was viewed as part of the intrinsic character of the individual. In the early history of resilience research, invulnerability was generally understood to be simply the absence of vulnerability. Attempts were made to characterize the invulnerable child as having specific qualities, including, for example, health, high energy, a good relationship with the mother, high self-esteem, and the ability to function autonomously (Anthony, 1974; Masten & Garmezy, 1985). Researchers viewed resilient or invulnerable children as those who had the ability to override their environment, and choose their own trajectory rather than have the environment dictate Discourses of Resilience, Enculturation and Identity 195 the outcome (Anthony, 1974). Low-risk environmental circumstances were simply one aspect influencing the invulnerable child, for whom inborn, unchanging qualities firmly determined their invulnerability. More recently, research has evolved to conceive of resilience as a process that emerges as the individual develops in accordance with changes they encounter in their lives, rather than as a fixed characteristic of the person or personality trait (Luthar et al., 2000). There is interest not only in what factors influence resilience, but in how the variety of factors an individual is exposed to in their lives might interact to contribute to resilience (Luthar, 1999). Resilience is no longer conceived of as an unusual characteristic, but is recognized as a common outcome reflecting “normative processes” (Masten, 2001, p. 234). Masten suggests that basic adaptive processes result in resilience under ordinary circumstances, while resilience is impaired when events undermine these adaptive processes, which include cognitive development, motivation to learn, and regulation of emotions. Thus, resilience has moved from being an unusual characteristic found only in certain hardy children, to a normal process which all children may exhibit, given the right circumstances. As research on resilience expands, it is increasingly applied to studies involving people of all ages, and groups from a variety of cultures and backgrounds, who face specific types of challenges. Examples of these diverse groups include: victims of post traumatic stress disorder (PTSD) (Young, 2007); gay and lesbian individuals who experience marginalization (Bonanno, Moskowitz, Pappa & Folkman, 2005; Russell & Richard, 2003; Sanders & Kroll, 2000); and Aboriginal peoples from communities that face a variety of perceived risk factors such as low socioeconomic status and high rates of substance abuse (Brady, 1993; Burack, Blidner, Flores, & Fitch, 2007; Stout, 2003). This broad application of the concept of resilience has involved shifts in the meaning of the concept—some explicit and intended, others more implicit or unexamined. In this paper we explore the implicit meanings of the concept of resilience as applied to Aboriginal peoples and communities. Our aim is to examine the ways in which resilience is constructed within research on Aboriginal peoples, and to examine the uses of this construct. We approach this through a discourse analysis of resilience literature that focuses on Aboriginal peoples. Discourse analysis allows us to examine the basis on which the resilience literature makes claims to truth, and explore the potential social and political implications of these claims (Fee, 2000). In the case of Aboriginal peoples, resilience research has been grafted onto a flourishing literature regarding the mental health needs and psychological wellbeing of indigenous populations and communities in North America and around the world (Waldram, 2004). Researchers and communities alike have become interested in protective factors that may contribute to resilience among those Aboriginal peoples who have faced adversities as a result of historical processes of colonization, marginalization and forced assimilation. Although, there is great diversity across Aboriginal communities in Canada, they have faced a common historical predicament and contemporary challenges with negative effects on their mental and physical health (Kirmayer, Brass, & Tait, 2000). This paper does not present an empirical analysis of resilience research regarding Aboriginal peoples, but an examination of the construct of resilience as it is found in a sample of the literature. The literature examined was obtained through a search of the PsychINFO database for the years 1984-2006, using the keywords ‘resilience’ and ‘Aboriginal’. The keyword Aboriginal was expanded to include other relevant terms

196 Tara L. Holton, Gregory M. Brass, & Laurence J. Kirmayer commonly used in the literature to refer to Aboriginal peoples, namely First Nations, Inuit, Indigenous, Métis and Native. This yielded 25 articles for analysis. The articles focused on a wide variety of Aboriginal peoples from Canada, The United States, Australia and New Zealand.

THE CONSTRUCT OF ABORIGINAL RESILIENCE

The discursive analysis revealed that the notion of resilience amongst Aboriginal peoples appears within the literature examined to be distinctive in comparison to the general literature, and was intricately linked to the concept of ‘enculturation’. This construct has a variety of implications, which are discussed in the following sections.

An ‘At Risk’ Population

The notion of resilience implies that an individual or group has faced some heightened level of risk or adversity. Accordingly, the psychological literature relevant to the topic of resilience among Aboriginal peoples can be separated into two categories, addressing risk and resilience, respectively. Present throughout the literature on resilience among Aboriginal peoples is the implication that this diverse group is an ‘at risk’ population; that is, Aboriginal peoples are viewed as more likely than the general population to be exposed to and susceptible to a variety of risk factors for illness, developmental difficulties or social problems. The concept of risk has come under sustained critical examination by social scientists (Beck, 1992; Giddens, 1991), who suggest that advanced industrial capitalist societies have become so conscious of and adverse toward a multitude of fears, perils and threats, they have become ‘risk societies’. Some have argued that the medical literature has created the appearance of a ‘risk epidemic’ (Skolbekken, 1995). In the mid-1960s less than 1% of the articles published in the leading medical journals were concerned with risk, compared to the early 1990s when the proportion increased to 6- 11%. Because the health and medical literature has a significant influence on social relations in Western societies, this trend has begun to reshape notions of selfhood and subjectivity, and it has the potential to influence notions of self across cultures more globally in a form of ‘cultural imperialism’ (Førde, 1998). Writing on the experience of women living under the threat of breast cancer, Sandra Gifford (1986) points out that while risk may have specific meanings and technical uses within epidemiological and clinical scientific discourses, it also has meaning in lay discourses about individual health and well-being. Deborah Lupton (1993), for instance, argues that the discourse of risk has usurped the former social category of ‘sin’ to describe a person’s moral standing in a health conscious society. The individual’s exposure to risk reflects a moral failure to live by the tenets of a recommended or normative healthy lifestyle. The experience of ‘risk’ has an embodied dimension and may lead women, in particular, to frame their bodily identity in terms of risk factors (Robertson, 2004). Recent years have seen the emergence of new forms of vulnerability, in which one must live with the threat of developing a future disease and may undertake drastic prevention measures, such as prophylactic mastectomy, the use of pharmaceutical agents or strict dietary regimens. In parallel with the medical and scientific literature, the use of risk in specific areas of the psychology literature has also increased significantly in recent decades (Heyman,

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2004). Although the ways that developmental psychologists and other scholars understand and deploy the concept of risk may differ from the use of the construct in epidemiology and health promotion, the psychological literature participates in the larger discourse of “the risk society.” Repeatedly characterizing entire ethnic and racial minority groups as at-risk populations or broadly suggesting they are more prone to certain risks may contribute to stereotypes and research bias. For example, the psychological literature on Aboriginal mental health tends to imply that simply being Aboriginal puts one at a disadvantage and thus makes one highly vulnerable to risk. Framing Aboriginal peoples as populations at risk, carves out a space for the study of resilience. The construction of risk justifies the existence of the resilience literature and its special relevance for Aboriginal individuals and communities. Consider the following examples:

The prevalence of substance use among Native youth is related to the fact that Native families have higher rates of ADOA [alcohol and other drug abuse] than families of any other ethnic group in the U.S. (U.S. Department of Health and Human Services, 1996) Accordingly, many Native adolescents live in families experiencing ADOA and its traumatic sequelae, including family violence, mental health problems, accidents, homicides, suicides, illnesses and child abuse and neglect. (Waller et al., 2003, p. 80)

A literature review of 140 research articles on risk and protective factors for alcohol, tobacco and other drug use identified individual, peer, family, school and community factors that constituted increased risk for substance use. Individual factors that were most commonly identified were alienation and rebellion. Peer alcohol, tobacco and other drug use, academic achievement and family cohesion were also identified risk factors. (Austin, 2004, p. 723)

Many factors have been associated with the current difficulties of Alaska Natives with alcohol abuse and addiction, other drug abuse, depression and suicide. One of the more prominent theories relates to ideas of deculturation (Abbott, 1998; Rodenhauser, 1994) and cultural oppression (Sullivan & Brems, 1997). (Lyness, 2002, p. 41)

Each of these excerpts lists a number of risk factors and resulting symptoms indicated as faced by Aboriginal peoples. Lists of risk factors, often described as supported by literature reviews from numerous studies, construct a version of the everyday life of Aboriginal peoples as fraught with risk. The first excerpt asserts that Aboriginal families have higher alcohol and drug abuse than any other ethnic group, and in turn suggests that this makes Aboriginal peoples more susceptible to violence, suicide, mental health problems etc. The second excerpt, backed by 140 research articles, lists numerous risk factors associated with risk for substance abuse, while the third excerpt describes how the ‘difficulties’ faced by Alaska Natives are associated with substance abuse, depression, suicide, and deculturation. By using the rhetorical feature of lists to illustrate the numerous risk factors faced by Aboriginal peoples, and unproblematically implying the ‘difficulties’ or ‘traumatic sequelae’ faced by Aboriginal peoples are a given, this pattern begins to construct Aboriginal peoples as a homogenous population

198 Tara L. Holton, Gregory M. Brass, & Laurence J. Kirmayer

‘at risk’ for nearly every mental health problem or socially dysfunctional behaviour one might imagine. One concern with such a process is that it ignores the enormous variation in exposure to risk factors by region, location and other crucial contextual determinants. Aboriginal peoples are homogenized and uniformly pathologized, justifying sweeping generalizations about their conditions and, ultimately, paternalistic regimes of intervention and ‘protection’. More subtly, despite their use in population studies, constructions of risk tend to individualize and ‘psychologize’ complex social and historical issues. The risk factors listed have their point of application at the level of the individual. Identifying individuals “at risk” allows researchers to frame their difficulties as psychological and locate them at the level of the individual instead of social and political processes (Burr & Butt, 2000, p. 186; Tester & McNicoll, 2004). This then locates any potential process of change at the individual level and sets the stage for resilience to be constructed as a personal responsibility to act in ways that avoid or counter risks. The understanding of resilience that emerges from the epidemiological risk literature differs greatly from the current emphasis in the developmental psychology literature, where resilience is understood as a process that develops as the person interacts with the social and cultural environment, resulting in ‘normal’ adaptations to a given context. In the case of writing on Aboriginal people, this process of interaction and developmental trajectory tends to be ignored in favor of global statements about ‘Aboriginal resilience’, part of a process of stereotyping and essentializing Aboriginal characteristics that has a long history in cross-cultural psychology (Waldram, 2004).

Enculturation

Discussions regarding enculturation, acculturation, and deculturation form a distinctive element of discussions of risk and resilience among indigenous peoples. Enculturation is a term used for the acquisition of a culture; acculturation refers to the process of culture change that occurs when two cultures encounter each other—often this is framed as a process of assimilation in which the dominant culture engulfs and absorbs the minority culture; deculturation is a term that has been used to denote the failure of enculturation, that is to say, a loss of culture. Many authors have suggested that the displacement and loss of indigenous cultures through the forces of colonization has rendered Aboriginal people more vulnerable and thus constitutes a risk factor for illness that works at both collective and individual levels. In the psychology literature, however, the impact of this collective political process of cultural domination and suppression usually has been examined only in terms of its impact on the identity and coping strategies of individuals. In the following excerpts, enculturation is represented as a curative factor that can reduce negative effects of stressors or increase the positive effects of buffers.

With numerous other researchers concerned with American-Indian alcohol use, we believe that “enculturation” is a resiliency factor that may protect against alcohol misuse or serve as an important curative factor in alcohol treatment programs. “Enculturation” refers to the degree to which individuals are embedded in their cultures as manifested by practicing the traditional culture and self-reported cultural identity (Zimmerman et al., 1994). For several decades

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(and historically among most tribal elders) there has been a movement to use traditional cultural knowledge in various treatment and educational settings. Although there are few controlled studies, an abundance of counseling and treatment publications and programs that espouse cultural relevance and cultural practices exist. (Whitbeck et al., 2004, p. 411)

Research on urban Native samples has suggested that identity attitudes (i.e. the extent to which one internalizes or externalizes attitudes toward oneself and one’s group) are important in enhancing self-esteem, coping with psychological distress and avoiding depression. Likewise, Zimmerman and colleagues proposed that enculturation, or the process by which individuals learn about and identify with their minority culture, is a protective mechanism that can either mitigate the negative effects of stressors or enhance the effects of buffers, decreasing the probability of negative outcomes such as drinking problems (Walters & Simoni, 2002, p. 521).

These excerpts represent enculturation as the process through which an Aboriginal individual may heal and demonstrate resilience through identification with Aboriginal culture. In the first excerpt, the authors indicate that for some time there has been a movement toward using cultural knowledge in the treatment of Aboriginal peoples, and that even though there is a lack of empirical evidence, this practice has been well established in counseling programs. The second excerpt suggests that forming a cultural identity is important for psychological wellbeing. It is implied that enculturation may prevent or at least reduce negative outcomes. This interest in enculturation is reflected in the recent rise of ‘cultural competence’ programs in North America and elsewhere. Over the last 20 years, culture has become an object of “institutional discourses” and has been constructed as a constitutive part of illness and a necessary aspect of treatment (Santiago-Irizarry, 1996, p. 18). There is a critical anthropological literature that addresses the ways in which identity, ethnicity and culture may be essentialized as traits (e.g., Santiago-Irizarry, 1996; Shaw, 2005). This essentializing is evident in the definition of enculturation, which implies that individuals are embedded in their culture and that their experiences and behaviour can be viewed as a reflection of collective values, norms, or themes. While individuals certainly participate in the cultures within which they live out their daily lives, constructing the individual as embedded within a culture through enculturation suggests that the process of becoming part of a culture makes over the individual in a distinctive, predictable, and uniform way. Absent in this view is any sense of culture as a system of conflicting and contested ideologies and practices that may also cause difficulties for individuals and which they may struggle against or actively resist. In terms of resilience, references to enculturation usually do not describe culture in any detail but treat it almost as a sort of inoculation, conferring resistance to the negative effects of subsequent life adversity. For theorists who employ the notion of enculturation, culture tends to be seen as something rooted in tradition and fixed in time, which resides within the individual, rather than something that is dynamic and variegated, shifting with time and context. Through the process of enculturation, individuals are embedded in their culture which becomes an essential quality of their identity. ‘Aboriginal resilience’ is understood as founded on such cultural embeddedness. Culture is part of the individual’s psychological wellbeing, and as such,

200 Tara L. Holton, Gregory M. Brass, & Laurence J. Kirmayer enculturation or reculturation allows the Aboriginal individual to be re-inserted into their culture are a path to resilience. This becomes more apparent within the literature as the construct of culture as cure emerges.

Culture as Cure

The concept of ‘culture as cure’ has been identified and critiqued in both the anthropological and psychological literatures (Brady, 1995; Santiago-Irizarry, 1996; Shaw, 2005; Wetherell & Potter, 1992). In the following passages, culture is described as a way to provide treatment or therapy and produce protective factors among Aboriginal peoples who face adversity.

In fact, according to Sullivan and Brems, all of the signs of difficulty in Alaska Natives are not causes of a decline in Native culture, but are in fact symptoms of the decline . . . (Lyness, 2002, p. 41). . . . A body of literature has begun to describe Native treatment approaches (both in Alaska and elsewhere) to a range of problems . . . . Several different approaches have been suggested as being helpful in working with Alaska Natives on alcohol-related problems as well as in mental health care delivery. (Lyness, 2002, p. 47)

Ethnic identity has long been posited as an important factor in an individual’s self-esteem and well-being. There is some evidence that culture-related factors such as revitalization of the indigenous language, religious customs, family- support systems and healing rituals are effective in reducing youth suicide and alcohol abuse among American Indian populations. (Austin, 2004, p. 724)

In both of the passages quoted above, culture is presented as a potential solution, a ‘cure’ for what the first excerpt describes as ‘signs of difficulty’ among Aboriginal groups. In the first excerpt, it is stated that the difficulties faced by Aboriginal peoples are not the causes of decline in Native culture, but are in fact symptoms of the decline. This locates the origins of social suffering in the decline or loss of Native culture. Native treatment practices are mentioned as being helpful in treating Native individuals for alcohol-related problems and in mental health care delivery. The second excerpt notes that ethnic identity may be an important factor in individuals’ self-esteem and well-being and, therefore, culture-related factors including language, tradition, family- support systems and healing rituals may be effective in reducing youth suicide and alcohol abuse among American Indian populations. The notion of ‘culture as cure’ is based on a psychological description of Aboriginal peoples suggesting that they lack culture and that this results in a loss of identity, strength and resilience, which accounts for difficulties in their lives. This suggests that in order to be healthy, Aboriginal people must recover their traditional culture and with it their authentic identity. Reclaiming culture is the solution to the individual and collective loss of identity and purpose. There is no recognition in this account that Aboriginal peoples have their own dynamic, evolving cultures (that may include many strands drawn from other traditions) and that they may achieve individual and collective resilience through other means. History and tradition are championed at the expense of other more contemporary routes to resilience. Reverence for tradition, defined in contrast to the values of mainstream society, leads to a valorization of culture as a cure for a broad range of individual and

Discourses of Resilience, Enculturation and Identity 201 social ills. Here culture is viewed as something unchanging, with its deepest and most authentic roots in a historical past. This past is simplified by viewing it primarily in terms of the injustices of the violent suppression and forced assimilation endured by indigenous peoples at the hands of colonizers and subsequent governments. The Aboriginal individual who is not engaged in a recuperation of tradition may then be viewed as lacking some essential or intrinsic source of personal strength. This critique is not meant to suggest that culture cannot be an important resource in the processes of resilience for people with Aboriginal (or any other) heritage, but rather, to point out how the static and essentialized view of culture present in much of this discourse works against a more nuanced and flexible understanding of the role of cultural knowledge, practices and identities for contemporary indigenous peoples (Sissons, 2005; Kirmayer, Brass, & Valaskakis, 2008).

CONCLUSION

We have sought to deconstruct the concept of resilience as it is employed in the literature on Aboriginal health. ‘Aboriginal resilience’ is constructed through a variety of discursive practices that establish Aboriginal peoples as a population at risk, with risk and resilience manifested largely in terms of individual psychological traits and characteristics. This allows researchers to psychologize any perceived difficulties faced by Aboriginal peoples and locates resilience at the level of the individual instead of social and political contexts (Burr & Butt, 2000). Because resilience thus construed is purely an individual characteristic, the responsibility for change is placed squarely on the individual. This understanding of resilience differs from the more processual models currently emphasized in the literature of developmental psychology, where resilience is understood as a normal process that develops through ongoing interactions of individuals with their social and cultural environment (Burack, Blidner, Flores, & Fitch, 2007). Even in this developmental literature, however, there is a relative lack of theoretical elaboration and empirical research on the social and communal factors that contribute to the emergence of resilience. Once the discursive phenomenon of ‘Aboriginal resilience’ as an individual trait is introduced, it is further reified by asserting a close relationship between resilience and culture. Here culture is the essential ingredient needed to make the individual strong. Culture becomes a set of traits embodied in the individual that confer resilience. This understanding of culture is supported by the discourse of culture as the curative ingredient which allows an Aboriginal person to achieve wellness, and which may be ‘enculturated’ into the Aboriginal person through various forms of cultural revitalization or return to tradition. Thus, the construct of ‘Aboriginal resilience’ as a trait in the form of traditional culture is established and perpetuated within the literature. The construction of Aboriginal culture as curative and the consequent emphasis on enculturation as paramount for an Aboriginal individual’s identity and health is not limited to the psychological literature. Programs to promote self-esteem, suicide prevention, and other interventions aimed to help Aboriginal individuals at risk, all emphasize the need for enculturation as a means of providing the individual with a strong sense of self, pride, and resilience. Ironically, it is common to find programs based on the tradition of one Aboriginal group being promoted as a solution to the problems experienced by entirely different Aboriginal groups. This is particularly evident in programs aimed at youth, where Aboriginal perspectives and Western

202 Tara L. Holton, Gregory M. Brass, & Laurence J. Kirmayer psychology are blended to create resilience strategies for children, Aboriginal and non- Aboriginal alike who come from diverse disadvantaged backgrounds (see Brendtro, Brokenleg, & Bockern, 2002). This appropriation, hybridization, and reinvention of traditions is consistent with the reality of cultures as dynamic, heterogeneous and constantly under revision (Kraidy, 2005). However, it challenges the view of culture implicit in much of the literature on Aboriginal resilience. Enculturation reifies culture in ways that may block understanding of its role in resilience. It promotes a view of culture as internal to the individual rather than as residing in dynamic contexts that emerge through the performances of individuals in interaction with others and with social institutions. Contrary to the manner in which it is represented in the resilience literature, culture is not a static body of knowledge or practices but a field of competing and contesting representations and forms of life. Culture does not provide pre-formed identities but makes available resources for developing multiple and hybrid identities through narrative constructions of the self and social positioning (Bhabha, 1994). The reification of culture through the language of enculturation risks forcing what Sissons (2005) calls “oppressive authenticity” on the individual; promoting new forms of exclusion and oppression based upon the binary opposition that exists between those who are embedded with culture and those who are not. The process of enculturation promotes culture as a reified commodity necessary for survival, and limits it to those who are its ‘authentic’ recipients. If risk identifies vulnerability, culture is associated with strength and resilience. However, reifying culture and treating it as a commodity ignores the transactional and intersubjective nature of cultural knowledge and identity. An interactional view of culture emphasizes the relationships of individuals and groups with the larger society and global systems. This interactional view is essential to understanding the politics of cultural knowledge and practice as potential sources of resilience for Aboriginal peoples. Ultimately, this discursive analysis highlights the need to re-vision ‘at risk’ populations not as pathologized victims, nor as the passive recipients of enculturation which instills traits or traditions, but as active agents, exhibiting forms of resilience that may not be defined or understood through western culture perspectives. As Johnson (2003) has pointed out, resilience for many Aboriginal peoples is “not an “ideal” position, but an attempt to shape and claim an identity within very difficult personal, tribal, social and economic systems” (p. 195). This is not to suggest that Aboriginal peoples are not constrained by these difficult situations, but that resilience for Aboriginal peoples includes the ability to adapt or develop competencies within the existing systems of their lives (Johnson, 2003). Re-visioning risk, resilience, along with culture and identity can work against the politics of “oppressive authenticity” among Aboriginal peoples, to allow new understandings of health and wellbeing to emerge.

REFERENCES

Anthony, E. J. (1974). The syndrome of the psychologically invulnerable child. In E. J. Anthony & C. Koupernik (Eds.), The child in his family: Children at psychiatric risk. (Vol. 3, pp. 201–230). New York: Wiley. Anthony, E. J., & Cohler, B. J. (1987). The invulnerable child. USA: Guilford Press.

Discourses of Resilience, Enculturation and Identity 203

Austin, A. A. (2004). Alcohol, tobacco, other drug use, and violent behavior among Native Hawaiians: Ethnic pride and resilience. Substance Use & Misuse, 39(5), 721-746. Beck, U. (1992). Risk society: Towards a new modernity. London: Sage. Bhabha, H. (1994). The location of culture. NY: Routledge. Bonanno, G. A., Moskowitz, J. T., Papa, A., & Folkman, S. (2005). Resilience to loss in bereaved spouses, bereaved parents, and bereaved gay men. Journal of Personality and Social Psychology, 88(5), 827-843. Brady, M. A. (1993). Health issues for aboriginal youth: social and cultural factors associated with resilience. Journal of Paediatric and Child Health, 29 (Suppl. 1), S56-59. Brady, M. (1995). Culture in treatment, culture as treatment. A critical appraisal of developments in addictions programs for indigenous North Americans and Australians. Social Science and Medicine, 41(11), 1487-1498. Brendtro, L. K., Brokenleg, M., & Van Bockern, S. (2002). Reclaiming youth at risk: Our hope for the future. Bloomington Indiana: Solution Tree. Burr, V., & Butt, T. (2000). Psychological distress and post- modern thought. In D. Fee (Ed.), Pathology and the postmodern: Mental illness as discourse and experience (pp.186–206). London: Sage. Fee, D. (2000). Pathology and the postmodern: Mental illness as discourse and experience. London: Sage. Førde, O. H. (1998). Is imposing risk awareness cultural imperialism? Social Science & Medicine 47(9), 1155-1159. Garmezy, N. (1971). Vulnerability research and the issue of primary prevention. American Journal of Orthopsychiatry, 41, 101–116. Gifford, S. M. (1986). The meaning of lumps: A case study of the ambiguities of risk. In C. R. Janes, R. Stall, & S. M. Gifford (Eds.), Anthropology and epidemiology: Interdisciplinary approaches to the study of health and disease (pp. 213-246). Dordrecht: D. Reidel. Giddens, A. (1991). Modernity and self-identity: Self and society in the late modern age. CA: Stanford University Press. Heyman, B. (2004). Risk and mental health. Health, Risk & Society, 6(4), 297-301. Johnson, G. G. (2003). Resilience, a story: A postcolonial position from which to [re]view Indian education framed in ‘at risk’ ideology. Educational Studies: A Journal of the American Educational Studies Association, 34(2), 182-198. Kirmayer, L. J., Brass, G. M., & Tait, C. L. (2000). The mental health of Aboriginal peoples: transformations of identity and community. Canadian Journal of Psychiatry, 45(7), 607-616. Kirmayer, L. J., Brass, G. M., & Valaskakis, G. G. (2008). Conclusion: Healing/Invention/Tradition. In L. J. Kirmayer & G. Valaskakis (Eds.), Healing traditions: The mental health of Aboriginal peoples in Canada (pp. 440-472). Vancouver: University of British Columbia Press. Kraidy, M. (2005). Hybridity, or the cultural logic of globalization. Philadelphia: Temple University Press. Lupton, D. (1993). Risk as moral danger: The social and political functions of risk discourse in public health. International Journal of Health Services, 23(3), 425-435. Luthar, S. S. (1999). Poverty and children’s adjustment. Thousand Oaks, CA: Sage. Luthar, S. S., Cicchetti, D., & Becker, B., (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543-562. Lyness, K. P. (2002). Alcohol problems in Alaska natives: Risk, resilience, and Native treatment approaches. Journal of Ethnicity in Substance Abuse, 1(3), 39-55. Masten, A. S. (2001). Ordinary Magic. American Psychologist, 56(3), 227-238. Masten, A. S., & Garmezy, N. (1985). Risk, vulnerability, and protective factors in developmental psychopathoogy. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical psychology (Vol. 8, pp. 1-52). New York: Plenum Press. Robertson, A. (2004). Embodying risk, embodying political rationality: Women’s accounts of risk for breast cancer. Health, Risk & Society, 2(2), 219-235. Russell, G. M., & Richards, J. A. (2003). Stressor and resilience factors for lesbians, gay men, and bisexuals confronting antigay politics. American Journal of Community Psychology, 31(3-4), 313- 328.

204 Tara L. Holton, Gregory M. Brass, & Laurence J. Kirmayer

Sanders, G. L., & Kroll, I. T. (2000). Generating stories of resilience: helping gay and lesbian youth and their families. Journal of Marital & Family Therapy, 26(4), 433-442. Santiago-Irizarry, V. (1996). Culture as cure. Cultural Anthropology, 11(1), 3-24. Shaw, S. J. (2005). The politics of recognition in culturally appropriate care. Medical Anthropology Quarterly, 19(3), 290-307. Sissons, J. (2005). First peoples: Indigenous cultures and their futures. London: Reaktion Books. Skolbekken, J. (1995). The risk epidemic in medical journals. Social Science & Medicine, 40(3), 291- 305. Stout, M. D. (2003). Aboriginal people, resilience and the residential school legacy. Ottawa: Aboriginal Healing Foundation. Tester, F. J., & McNicoll, P. (2004). Isumagijaksaq: mindful of the state: social constructions of Inuit suicide. Social Science & Medicine, 58(12), 2625-2636. Waldram, J. (2004). Revenge of the Windigo: The construction of the mind and mental health of North American Aboriginal peoples. Toronto: University of Toronto Press. Waller, M. A., Okamoto, S. K., Miles B. W., & Hurdle, D. E. (2003). Journal of Sociology & Social Welfare, 30, 79-94. Walters, K. L., & Simoni, J. M. (2002). Reconceptualizing Native women's health: An ‘indigenist’ stress-coping model. American Journal of Public Health, 92(4), 520-524. Wetherell, M., & Potter, J. (1992). Mapping the language of racism; Discourse and the legitimation of exploitation. New York: Columbia University Press. Whitbeck, L. B., Chen, X., Hoyt, D. R., & Adams, G. W. (2004). Discrimination, historical loss and enculturation: Culturally specific risk and resiliency factors for alcohol abuse among American Indians. Journal of Studies on Alcohol, 65(4), 409-418. Young, A. (2007). Posttraumatic stress disorder of the virtual kind: Trauma and resilience in post-9/11 America. In A. Sarat, M. Alberstein, & N. Davidovitch (Eds.), Trauma and Memory: Reading, Healing, and Making Law (pp. 21-48). Stanford, California: Stanford University Press.