The sequential, constructed process of the adversity impact

In order to appreciate the effects of adversities on involuntarily dislocated individuals, it is essential to disentangle epistemologically the very process of how adversity impacts on people in general. Building on what has already been explored in this book, the first differentiation that needs to be made is between the initial reaction, when one is exposed to any form of adversity, and the lasting effects that tend to be associated with the mark adversity leaves on a person.

It is reasonable to expect, by and large, that adverse events produce adverse impacts on people. When ordinary civilians barely manage to escape camage and destraction, it is inevitable that they will be petrified, have physical reactions, e.g. shaking, screaming, hyperventilating, etc. All these are appropriate responses to adverse circumstances. The opposite would have been inappropriate, i.e. to remain unmoved without being affected by such life-threatening events.

My argument is that whatever immediate reactions one has to such devastating events would be appropriate and understandable. Even psychotic tendencies of distorting reality, paranoid states of suspecting everybody as a potential attacker, bouts of depressive withdrawal - all of these would fall into the same category, i.e. of appropriate responses to adverse circumstances. One may object to accepting all such reactions as appropriate and may insist on considering certain reactions as disproportional to that particular type of adversity and, therefore, as signs of real pathology.

It is precisely in response to such objections that the criteria for diagnosing PTSD, according to the latest Diagnostic and Statistical Manual (DSM 5) of the American Psychiatric Association, specify the ‘duration’ that we should allow before the symptoms are diagnosed as PTSD. First, it clarifies that all the identified symptoms need to persist ‘more than one month' and then, in relation to ‘delayed expression’: ‘full diagnosis is not met until at least six months after the trauma(s), although onset of symptoms may occur immediately’. This clarification is extremely important and is an admission that any symptoms, within at least one and then six months after the actual exposure to adversity, should be accepted as falling within the ‘normal’ range of reactions. This, of course, does not mean that such reactions, behaviours, feelings etc. are not debilitating and obnoxious for the sufferer. The point is that, regardless of their distressing nature and unbearableness, they still fall within the range of what is expected, given that the person was exposed to such devastating forms of adversity. Considering all forms of distress as manifestations of (psychiatric) disorder is a grave epistemological error.

What matters most is what follows after those initial reactions. Inevitably, these reactions will have a profound impact on the person and on the others around him/ her. Not only the original events and circumstances of adversity, but the reactions themselves will impact all concerned. What does it mean to the affected persons themselves, and to others close to them, that they have such reactions/'symptoms’? What does it mean, for example, for a father who previously always faced difficulties calmly and efficiently and now cries incessantly, is unable to sleep properly, worries all the time, does not let any member of his family out of his sight, etc.? What impact will these reactions have on him and his family? In short, when facing such uncharacteristic behaviour (which is the reaction to the adverse events), the affected persons would either perceive them as ‘appropriate responses to adverse circumstances’ or as indications that they are now disturbed to a degree that requires specialist psychological or even psychiatric attention. Needless to say, there are many more positions in between these two extreme polarities.

What determines the way the affected persons perceive these reactions as well as the original adverse events and circumstances'! What factors affect whether expressions of distress are perceived as a disorder!

The example of the two Bosnian men who came to London as refugees (discussed in Chapter 1) is indicative of what I am examining here. As a reminder, they were affected by their overall experiences in diametrically different ways, although they were exposed to the same forms of adversity, exhibited the same initial reactions, and benefitted from identical types of reception in the UK: one adopted the identity of a passive victim, feeling that he was scarred for life, whereas the other one came out of his ordeal feeling strengthened by his ability to overcome adversity, adopting the identity of a very active survivor.

This means that the two different ultimate outcomes are not directly and causally produced (based on the simplistic S-R formula) either by the original events or by their initial reactions, all of which were identical. Instead, they are the products of how their initial reactions were perceived and processed by each man and by those close to them within the context of the wider societal narratives. Therefore, the lasting mark adversity has on a person depends on the meaning that is given to the initial reactions and symptoms. By meaning, here I understand the overall sense one has about the cluster of reactions to the adversity, e.g. are they perceived as appropriate and understandable under the circumstances or are they taken as signs of pathological disturbance? The term meaning is used here not as the outcome of a conscious, cognitive deliberation that can be articulated clearly in logical language. Instead, it refers to the general sense one has, mainly non-consciously, about a phenomenon (Papadopoulos, 2020). This meaning is the byproduct of a number of factors and processes that will be discussed now.

The key implication of my central argument here is that these lasting effects should be understood as a mediated response, which comes after the initial reaction to the adversity. More precisely, this mediated response is a constructed response, formed by what I term Meaning Attribution Processes (MAPs). In the case of the two Bosnian men, whereas the first man constructed a meaning of his distressing reaction to his adversities as a disorder, the second man construed the very same distress as a normal response to abnormal circumstances and used it to spur him on in life.