Narratives of adults with intellectual disabilities evacuated from combat zones : personal identity, quality of life and future orientation (Hebrew)

The primary objective of the present study was to examine the subjective experiences of individuals with intellectual disabilities who were evacuated from combat zones, and to explore how the evacuation events influenced their life narratives concerning of personal identity, quality of life, and future orientation.

The study was grounded in the autobiographical memory model (Baddeley, 1988; Harris et al., 2014; Pillemer, 1992), which serves as a pivotal element in the formulation of life narratives. This model facilitates the  organization of experiences, the retrieval of significant life events, and the extraction of  knowledge and meaning from those experiences. Within this framework, the three main functions of autobiographical memory were examined: the self function (personal identity), which emphasizes self-continuity and the construction of identity; the social function, which relates to the shaping of one’s quality of life; and the directive function (future orientation), which involves planning, problem-solving, and attributing meaning to one’s life trajectory.

In addition, the study explored how two theoretical approaches the pathogenic and the salutogenic (Antonovsky, 1987; APA, 2022), were reflected in participants’ narratives. The pathogenic approach emphasizes the traumatic impact of exposure to extreme events such as war and evacuation, whereas the salutogenic approach focuses on health-promoting resources and on identifying General Resistance Resources (GRRs) that assist individuals maintain a sense of coherence and resilience during crises.

Five research questions were formulated, focusing on identifying pathogenic and salutogenic expressions in participants’ narratives, examining the impact of evacuation on their sense of personal identity, identifying factors affecting their quality of life, and exploring how the war shaped their perceptions of the future.

The study involved 14 adults with intellectual disabilities residing in supported housing facilities in northern Israel, who were evacuated together to a rural hostel during the war. A qualitative narrative methodology was employed, using semi-structured interviews guided by the three autobiographical memory functions and the theoretical approaches described above. 

In addition, the Peabody Picture Vocabulary Test (Dunn & Dunn, 2007) was administered to assess participants’ verbal-cognitive abilities. Data analysis was conducted in three stages (Shkedi, 2003; Tracy, 2024): open coding, axial coding, and synthesizing and making meaning from codes, through which the main themes were identified. Complementary statistical analyses were performed using Pearson correlations to examine the relationships between age, cognitive level, and the thematic categories, and independent-sample t-tests to assess gender differences.

The findings revealed three major themes: Personal identity between trauma and resilience, Quality of life under evacuation, and Future orientation. Each theme encompassed both pathogenic and salutogenic expressions, reflecting the dynamic interplay between vulnerability and growth, and participants’ capacity to construct meaning amid extreme situations.

In the first theme, personal identity between trauma and resilience, a complex picture emerged, combining experiences of loss and coping. Participants described decreased autonomy and independence following the evacuation, which intensified feelings of dependency and undermined their sense of self. The loss of employment settings perceived as sources of meaning, self-worth, and social belonging deepened their sense of loss. The rapid evacuation was experienced as traumatic, disrupting life continuity and personal stability.  These were expressions of the pathogenic approach. However, relationships with family members and friends were described as a source of resilience and support, which helped the participants maintain a sense of belonging and cope with the changes they experienced representing the salutogenic approach.

In the second theme, quality of life under evacuation, participants reported a decline in their quality of life, manifested in reduced privacy, decision-making, and emotional well-being. They described loss of control over daily routines and decreased privacy conditions that contradict values of personal choice, independence, and private space, which are essential for enhancing quality of life among people with intellectual disabilities (McCarron et al., 2019). These represent the pathogenic aspect of the evacuation experience. Conversely, the presence of professional staff who accompanied them during the evacuation was described as a vital source of resilience providing safety, structure, and a sense of visibility; salutogenic elements that helped preserve a sense of coherence and stability.

In the third theme, future orientation, expressions of both hope and uncertainty were evident. Participants expressed a longing to return to their pre-war routines, work, and leisure activities, and demonstrated confidence in their ability to recover an expression of the salutogenic approach, characterized by planning and hope. However, uncertainty about the future, particularly concerning the end of the war and lack of control over reality, created emotional strain and influenced their perception of the future, reflecting the pathogenic aspect of the experience.

Overall, the findings reveal that the participants' narratives contain both pathogenic and salutogenic approaches, creating a complex picture. Alongside recognition of pain and loss, participants demonstrated the ability to draw strength from social support, meaning, and hope, suggesting that both approaches together provide a comprehensive framework for understanding the experiences of individuals with intellectual disabilities in extreme crisis situations.

The theoretical contribution of this study lies in proposing an integrated framework for understanding coping among individuals with intellectual disabilities during emergencies. From a pathogenic perspective, the study highlights the structural and psychological vulnerabilities resulting from dependence on external systems and their impact on personal identity and quality of life. From a salutogenic perspective, it identifies internal and social resilience mechanisms that enable processes of recovery, meaning-making, and emerging hope. Moreover, integrating the pathogenic and salutogenic approaches with the autobiographical memory model (Bluck et al., 2005) provides a deeper understanding of trauma processing among individuals with intellectual disabilities.

In terms of practical implications, the findings underscore the need to develop tailored social policies and emergency services for individuals with intellectual disabilities. This population faces unique and significant challenges during crises, requiring systemic, rights-based, and adaptive responses.