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How to Fail a Scale: Reflections on a Failed Attempt to Assess Resilience

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How we interpret concepts from suffering to survival has been historically debated in the field of anthropology, transcultural psychiatry, and global mental health. These debates have centered on the notion that such concepts are cross-culturally reproducible, although scholars who work the boundaries of culture, medicine, and psychiatry often triangulate methods from internationally standardized scales to various interpretive methods from participant observation to narrative. This article considers resilience, as opposed to suffering, as the subject of a reproducible entity by discussing the failure of an attempt to capture resilience via an internationally reputed scale called the “Resilience Scale for Adults” among cancer patients in urban South Africa. Our effort to utilize the internationally validated scale, and our attempt to draw on ethnographic and interview work to translate this scale to a locally relevant entity failed due to linguistic, cultural, and practical issues. In brief, the attempt failed because our resilience scale was too long, syntactically ambiguous, and culturally inappropriate. We write this article to spur a larger conversation about evaluating resilience from scale to ethnography, and how the concept and measurement of resilience might figure into fields of anthropology and medicine.

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This field methods paper was prepared with the financial support of the Provost Office and SFS Dean’s Office from Georgetown University. The second author was supported by the National Science Foundation Graduate Research Fellowship.

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Correspondence to Emily Mendenhall.

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Appendix 1

Question: I’ll now describe a scenario and ask you some questions about your thoughts about this example. Imagine a person named Sibongile, a middle aged adult from Soweto who experienced a severe car accident 6 months ago. Today they are back at work, functioning fine, and not too stressed. Now imagine another person, Grace, also a middle aged adult from Sophiatown who went through a similar car accident but is continuing to experience a number of health problems, such as migraines, aggressive behavior, and anxiety. What might be the reason that they had different outcomes?

[Probes: Why was Sibongile able to cope/recover well? Why was Grace unable to cope/recover well? Thinking of people in your community who are like Sibongile, what things help them to recover when they experience things like [traumatic events]? What things make it difficult for them to cope with stress and recover? How can you tell/recognize when someone can/cannot cope and recover well?]

Appendix 2




Personal strength/perception of self

 (1) I always find a solution when something unforeseen happens

(1) When something unexpected happens, I always find a solution

Positive outlook

 (2) I know how to solve my personal problems

(2) I know how to solve the problems in my life


 (3) I strongly believe in my abilities

I am capable (I strongly believe in my abilities)

This was dropped because it was not translatable

 (4) I completely trust my judgments and decisions

(3) I trust my judgments and decisions


 (5) In difficult periods, I have a tendency to find something good that helps me thrive

(4) When life becomes difficult, I find something or someone to help me keep going


 (6) I manage to come to terms with events in my life that I cannot influence

(5) I manage to accept things I cannot change


Personal strength/perception of future

 (7) My plans for the future are possible to accomplish

(6) I can achieve my plans for the future

Goal orientation

 (8) I know how to accomplish my future goals

I know how to accomplish my future goals (plans for the future)

Dropped due to repetition

 (9) I feel that my future looks very promising

My future looks bright (successful)

Dropped due to repetition

 (10) My goals for the future are well thought through

My future is well planned

Dropped due to repetition

Structured style

 (11) I am at my best when I have a clear goal to strive for

(7) I like to have a clear idea of what work towards

- Initial question is confusing, dropped “goal”

Aims and objectives

 (12) When I start on new things/projects, I prefer to have a thorough plan

(8) When I start a new activity or project, I prefer to have a good, well thought out plan

- Step-by-step is resonant among participants

- “Thorough” is confusing


 (13) I am good at organizing my time

(9) I am good at organizing my time

Organizational skills

 (14) Rules and regular routines simplify my everyday life

Following rules makes my life easier

Dropped due to repetition

Social competence

 (15) I enjoy being together with other people

(10) I enjoy being with other people

Positive social orientation

 (16) To be flexible in social settings is really important to me

(11) It’s easy for me to adapt to social situations


 (17) New friendships are something I make easily

(12) I make friends easily

Making contact

 (18) Meeting new people is something I am good at

I am good at meeting new people

Dropped due to repetition

 (19) I easily laugh when I am with others

(13) I laugh easily when I am with others


 (20) For me, thinking of good topics for conversation is easy

(14) I communicate well with new people (I make conversation easily)

Comforting others

Family cohesion

 (21) My family’s understanding of what is important in life is very similar to mine

(15) My family and I agree on what is important in life (share the same values)

Shared values

 (22) I feel very happy with my family

(16) I am very happy with my family


 (23) My family is characterized by healthy coherence

(17) I have a tight family (My family sticks together, is close)


 (24) In difficult periods my family keeps a positive outlook on the future

(18) When life becomes difficult, my family keeps a positive attitude

Common positive outlook

 (25) Facing other people, our family acts loyal towards one another

My family is loyal to one another, even when we are challenged

Dropped due to repetition Common perspective

 (26) In my family we like to do things together

My family likes to do things together

Dropped due to repetition

Social resources

 (27) I can discuss personal issues with friends/family- members

I can discuss personal issues with my friends and family

Dropped due to repetition

 (28) Those who are good at encouraging me are some close friends/family members

(19) My family is good at encouraging me

Consider dropping for religion question


 (29) The bonds among my friends is strong

(20) My friends and I have strong bonds


 (30) When a family member experiences a crisis/emergency, I am informed right away

If a family member has an emergency, someone calls me right away

Dropped due to repetition

 (31) I get support from friends/family members

I get support from friends and family

Dropped due to repetition

 (32) When needed, I always have someone who can help me

(21) I always have someone who can help me when needed


 (33) My close friends/family members appreciate my qualities

(22) My family appreciates me

Appreciated by others


(23) I turn to my religion for support during hard times


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Mendenhall, E., Kim, A.W. How to Fail a Scale: Reflections on a Failed Attempt to Assess Resilience. Cult Med Psychiatry 43, 315–325 (2019).

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