Introduction
The concept of resilience has shifted over time in response to critiques and contributions from scholars seeking to apply it to diverse populations. At its core, however, it explores responses to adversity. Comprehensive reviews of the evolution of thought around resilience have been conducted by others (Luthar et al., Reference Luthar, Cicchetti and Becker2000; Masten et al., Reference Masten, Lucke, Nelson and Stallworthy2021), and are not the focus here. However, it is applicable to note that health inequity scholars, particularly those engaged with questions of structural and systemic racism and subjugation, have become increasingly vocal about the limitations of resilience (Biermann et al., Reference Biermann, Hillmer-Pegram, Knapp and Hum2016; Humbert & Joseph, Reference Humbert and Joseph2019; Mahdiani & Ungar, Reference Mahdiani and Ungar2021). This is true for those whose focus is Indigenous health (Kirmayer et al., Reference Kirmayer, Dandeneau, Marshall, Phillips and Williamson2011; Weiss et al., Reference Weiss, Anderson, Bolton-Steiner and Walls2022).
While not exhaustive, concerns include the onus placed on individuals or communities to compensate for adversities experienced, often regardless of the structural nature of the original threat. Additionally, there is acknowledgement of inappropriate assignment of blame, including narratives of weakness and pathology, with respect to those who are unable to meet societal expectations of recovery (Hart et al., Reference Hart, Gagnon, Eryigit-Madzwamuse, Cameron, Aranda, Rathbone and Heaver2016; Horn, Reference Horn2021; Usher et al., Reference Usher, Jackson, Walker, Durkin, Smallwood, Robinson, Sampson, Adams, Porter and Marriott2021). Similarly problematic is the assignment of the title “resilient” to a wildly heterogenous Indigenous population, often in response to equally heterogenous experiences of adversity (though stemming from a shared history of colonial subjugation). This can lead to an associated perpetuation of the narrative of Indigenous Peoples as static and timeless, frozen in cycles of subjugation, trauma, and responsive resilience. For these reasons and others, Indigenous health scholars, practitioners, and community members have pushed back against the limitations of resilience as a descriptor of modern Indigeneity.
Efforts to employ the strengths of conventional resilience models alongside methods that engage with Indigenous realities of colonization, subjugation, and enduring structural barriers have stemmed from recent multisystem perspectives on resilience. These have resulted in an off-shoot of resilience research and literature termed “Indigenous resilience” (Allen et al., Reference Allen, Hopper, Wexler, Kral, Rasmus and Nystad2014; Hatala et al., Reference Hatala, Desjardins and Bombay2016; Kirmayer et al., Reference Kirmayer, Dandeneau, Marshall, Phillips and Williamson2011). Indigenous resilience differs from conventional resilience in definition, honing in on positive outcomes despite both historical and current adverse pressures at the level of individuals, families, communities, and larger social groups (while conventional resilience focuses primarily on adversity, most typically over the individual life course). The stage of life emphasized in conventional resilience, particularly within developmental pathology, is that of children or youths, while Indigenous resilience is inclusive of Indigenous Peoples at all developmental and life stages.
Despite the efforts made to alter “resilience” to fit the needs of Indigenous people and researchers, there remain limitations within the terminology. Rather than continue to develop amalgamations of resilience, some scholars of Indigenous health have begun to employ the term survivance. Survivance is a neologism introduced by Anishinaabe scholar Gerald Vizenor in 1994 (Vizenor, Reference Vizenor1994). A combination of survival and resistance, the term represents continuation through stories and active presence. Active presence differs from the passive via “personal attributes, such as the native humanistic tease, vital irony, spirit, cast of mind, and moral courage” (Vizenor, Reference Vizenor2008, p. 1). A literary scholar, Vizenor perceived survivance as being crafted and enacted through narrative, as the continuation of stories of “cultural conversion and native modernity” (Vizenor, Reference Vizenor1999, p. x). Integral to the concept of survivance is the interruption of what Vizenor calls manifest manners, the “course of dominance, the racialist notions and misnomers sustained in archives and lexicons as ‘authentic’ representations of Indian cultures” (Vizenor, Reference Vizenor1999, p. vii). Manifest manners are the static, inaccurate stereotypes of Indigenous Peoples often recalled by resilience narratives. Survivance, on the other hand, is “an undeniable trace of presence over absence, nihility, and victimry” (Vizenor, Reference Vizenor2008, p. 17).
Although originally applied within literary domains, the concept of survivance immediately gained purchase in adjacent disciplines such as visual media, material culture, and education. Despite its initial popularity the term then remained largely siloed, with its emergence into the social and health sciences occurring much more recently. While the term carries significant potential as an alternative to terms like resilience, by nature of its postmodern literary origins, it has resisted narrow definition and eluded measurement. Given the increasing appearance of survivance in relation to health, we performed a scoping review in order to understand how the concept of survivance is being applied in health scholarship, with a particular interest in its relationship to resilience.
Method
Protocol
The protocol for this scoping review followed Arksey and O’Malley’s methodological framework (Arksey & O’Malley, Reference Arksey and O’Malley2005). The draft protocol was revised following review by members of the research team and consultation with research librarians at Harvard University and Harvard Medical School. A scoping review format was determined to be appropriate to address this research question given our desire to “examine the extent, range and nature of” (Arksey & O’Malley, Reference Arksey and O’Malley2005, p. 21) the health-centered survivance literature, and to summarize and disseminate the scope of existing literature on the topic, in order to focus and inform future health-centered survivance research and practice. We adhered to Arksey and O’Malley’s five-stage framework: 1) Identify the research question, 2) Identify relevant studies, 3) Select studies, 4) Chart the data, and 5) Collate, summarize, and report the results.
Identification of relevant studies
Eligibility criteria for inclusion in the final scoping review included 1) papers that contained the term “survivance” anywhere within the document, 2) English language, 3) human-centered, 4) focused on health, wellbeing, or healing, as defined in the World Health Organization’s (WHO’s) constitution as “… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2023), and 5) works completed by scholars other than Gerald Vizenor and outside of volumes edited by him (as the aim of this work was to identify how scholars were applying Vizenor’s concept). Papers that included exclusively similar words to survivance, such as survival, were excluded, as were those without an English translation or that focused on nonhuman topics, such as deoxyribonucleic acid or bacteria. Those that failed to mention health or healing, were also excluded. Included work was not required to have an Indigenous focus as we were interested in the use of survivance within the health literature regardless of population. All types of papers returned by the search platforms were included, including research papers, editorials, reviews, commentaries, and dissertations. Not included in this scoping review were websites detailing health interventions not written up in the literature.
A comprehensive literature search was guided by consultation with two research librarians and conducted by the first author. Methods and search results were reviewed by the senior author. The search was inclusive of the following five databases, selected because of their proximity to health-associated literature: Web of Science, PubMed, PsycINFO, Global Health, and Cumulative Index to Nursing and Allied Health Literature Complete. An additional search of the first three pages of Google Scholar, as a grey literature source, was used to confirm the presence of all key works from the primary search. References lists from included articles were further scanned to ensure saturation. No limitations were placed on year of publication, however, the literature search was conducted in October and November of 2022, limiting results to late-2022 or earlier.
Selection of studies
Comprehensive search results by author, title, and year were imported into Microsoft Excel (total of 527 articles), and duplicate results were excluded, leaving 440 papers remaining. Level 1 screening consisted of reviewing study titles to ensure that eligibility criteria two (English language, 369 remaining) and three (human-centered, 304) were met. One paper identified during this phase of screening was inaccessible and was therefore excluded by necessity from analysis. Level 2 screening consisted of reading the full text of each document to ensure that all eligibility criteria were met, including criterion 4 (health-focused), resulting in 32 papers that were included in analysis.
Charting the data
From all included articles we extracted data on author, title, year of publication, country, and population of focus (limited to broad categorization of population; for example, papers focused on Anishinaabe peoples were included under the code “American Indian and Alaska Native”), intervention status (yes, no, or in a few specific cases details about theoretical interventions or nontraditional academic interventions), aim, methodology, health focus, use of survivance within the text (qualitative text-captures), measurement of survivance (if quantified), Vizenor definition cited, type of document (journal article, dissertation, other), field of study, and wherein the document survivance was used (title, abstract, keywords, and body of text). The initial data extraction form was piloted on five randomly selected papers before being modified to be inclusive of additional items of interest. In keeping with guidance for conducting scoping reviews (Peters et al., Reference Peters, Godfrey, Khalil, McInerney, Parker and Soares2015) we did not assess methodological quality or bias risk of included papers.
Collation and summarization of data
Synthesis included quantitative frequency analysis of the following descriptive variables: publication year, publication type, discipline, location in paper of survivance, country of focus, and population of focus. Frequency analysis was also conducted for the following content variables: intervention status, mention of historical trauma, methodology, health focus, measurement, and Vizenor definition and citation. For every included document, each paragraph that included reference to survivance was extracted for qualitative analysis.
Qualitative content analysis was used to identify themes in the use of survivance within included articles using the six steps of Braun and Clarke’s thematic approach (Braun & Clarke, Reference Braun and Clarke2006): 1) familiarization with the data by conducting a comprehensive read-through of the extracted sections, 2) generation of codes via the systematic review of interesting features within the dataset and the collation of relevant data for each code, 3) examination for themes through the identification of potential categories followed by the collection of all data relevant to each theme, 4) confirmation of themes, by reviewing themes in relation to earlier codes and the dataset as a whole, 5) development of theme definitions by conducting ongoing analysis into the specific elements of each theme and their role in the analysis as a whole, and 6) production of the report through selecting the most compelling and representative examples of each theme for presentation.
Each of these six steps was completed by the first author, with the second author performing a secondary review. A word cloud of qualitative content was developed using wordclouds.com. The font size of each word occurring in the qualitative content was weighted depending on frequency with which the word appeared in the text (see Figure 2).
Results
Characteristics of usage of the term survivance across papers are reported for both frequency analysis and content analysis.
Frequency analysis
Descriptive
Table 1 shows the entirety of extracted data used to perform the frequency analysis while Table 2 includes frequency analysis results. The 32 papers included in the scoping review were published between 2009 and 2022, with a single paper emerging each in 2009 and 2010 (a doctoral dissertation and a journal article, respectively), followed by one or more annually from 2014 on, with between four and seven published annually in 2019–2022. Journal articles were the most frequent medium at 78%, while the remaining 22% were doctoral dissertations. A total of 63 authors contributed to the 32 papers, with one author participating in four papers, and one in two papers. The remaining 61 authors appeared in the review only once.
Table 1. Scoping review publications and findings (in chronological order of appearance)
Table 2. Descriptive and content frequency analysis results
Overall, 22 disciplines were represented in the sample, with psychology (19%) and social work (13%) being the most common. The term survivance appeared most often within both the abstract and body of the text (34%), followed by appearances in both the title and body of the text (19%). The majority of papers (58%) focused on the United States and Canada (22%). Of the papers, which focused on the United States, 89% focused on American Indian or Alaska Native populations, while 11% focused on African American populations. Overall, the majority of papers, 91%, had an Indigenous focus.
Substantive
While 9% of included papers were developed explicitly to support future health interventions, none detailed an existing intervention, and 78% addressed a nonintervention health topic. Of the 32 papers, 59% were empirical studies. A plethora of methodologies were represented, with many papers utilizing more than one. The most frequent methods represented were ethnography (13%), storytelling and oral histories (13%), interviews (13%), and digital media (13%), while 34% of papers were purely descriptive. The papers represented a diversity of health focus, the most frequent being individual or community health or well-being (28%) followed by healing (broadly) (25%), mental health (suicide, substance use, and psychosocial stress) (22%), and trauma or violence (22%). More than three-quarters of papers (78%) involved discussion of historical trauma or a related term like traumatic past or historical oppression.
Fewer than half of the papers (41%) included a tangible measurement of survivance. Only 59% provided a quote from Vizenor defining the construct, and of these, the most frequently used were, “… an active sense of presence, the continuance of native stories, not a mere reaction, or a survivable name” (21%) (Vizenor, Reference Vizenor1999, p. vii), “… renunciations of dominance, tragedy, and victimry” (19%) (Vizenor, Reference Vizenor1999, p. vii), and “… a sense of native presence over absence, nihility, and victimry. Native survivance is an active sense of presence over absence, deracination, and oblivion” (13%) (Vizenor, Reference Vizenor2008, p. 1). For complete details of Vizenor quotes employed by authors, see Table 3. Eight works by Vizenor were cited, most frequently Manifest Manners: Narratives on Postindian Survivance (62%) (Vizenor, Reference Vizenor1999), Survivance: Narratives of Native Presence (50%) (Vizenor, Reference Vizenor2008), and Manifest Manners: Postindian Warriors of Survivance (13%) (Vizenor, Reference Vizenor1994).
Table 3. Analytic details of Gerald Vizenor quotes employed by authors of scoping review documents
Content analysis
Given the diversity of aims and disciplines represented within the articles included in this scoping review, it is striking that five key themes pertaining to adoption of the concept of survivance were identifiable across papers: narrative (n = 17), temporality (n = 13), community (n = 11), decolonization (n = 11), and sovereignty (n = 9) (See Figure 1). While these themes also reflect attributes of the concept as described by Gerald Vizenor in 1994 (Vizenor, Reference Vizenor1994), authors of articles in this review applied these themes in unique ways for a health professional and research audience, such as focusing on healing and wellbeing.
Figure 1. Conceptual map of themes for health survivance (# of publications endorsing themes).
Figure 2. Word cloud of survivance-adjacent content. content is presented in case-neutral form and is not indicative of capitalization norms or practices.
Narrative (n = 17)
Survivance narratives are employed in relation to health, wellbeing, and healing in three distinct ways: the first focuses on the act of changing the narrative around Indigeneity from one that is deficit-based toward one that celebrates Indigenous strengths, the second offers sweeping statements about improved well-being, while the third, and by far the least common, provides clear examples of ways in which narrative shift actively impacts health or healing.
Changing the Narrative (n = 11). The subtheme of changing the narrative, thus altering discourse, involves transitioning from narratives that are colonially defined to those that are celebrations of Indigeneity. In relation to health, the focus of this theme is on shifting from narratives of illness and deficit to those of wellness and strength. Wieskamp and Smith (Reference Wieskamp and Smith2020) provided a clear example of this adaptation, writing:
Survivance… provides an important resource for communities struggling with the effects of violence. Challenging the vanishing race myth, survivance articulates an active presence in which both the struggles and perseverance of Native voices, identities, and cultures are seen and heard. In challenging dominant understandings of trauma, survivance rejects the imagination of a stable subject position that comes before and after trauma and instead advances an enduring sense of renewal. (Wieskamp & Smith, Reference Wieskamp and Smith2020, p. 73)
In relation to the impacts of narrative change on healing for a specific population of Indigenous Peoples, Ramirez and Hammack (Reference Ramirez and Hammack2014) added:
Our analysis suggested that personal and historical trauma were intertwined in the life-story narratives of these men. Yet, these narratives are not that of traumatized victims, instead, they embody the theme of survivance. That is, we interpreted these men’s ability to respond to personal and collective trauma by constructing resilient life-story narratives as a form of resistance. (Ramirez & Hammack, Reference Ramirez and Hammack2014, p. 127)
Generalized Statements of Healing (n = 11). While authors made clear connections between changing narratives from those focused on trauma and pathology to those emphasizing resilience, renewal and improved well-being, the beneficial mechanism was rarely clearly articulated. Instead, more general statements on healing (broadly) as the outcome of narrative shift were common. An example of this was provided by Manuelito (Reference Manuelito2015):
…control of “our” image [and stories] becomes not only an act of subversion, but of resistance, and ultimately, liberation…[merging] Indigenous oral traditions and storytelling with new technology to create first-person digital stories that will bring forth survivance, healing, and liberation. (Manuelito, Reference Manuelito2015, p. 75)
Similarly, Sun et al. (Reference Sun, Goforth, Nichols, Violante, Christopher, Howlett, Hogenson and Graham2022) eloquently demonstrated the perceived connection between narrative shift and “radical healing:”
Standing in stark contrast to the image of being absent, victimized, damaged, and broken – an image of how indigenous communities are typically portrayed, survivance features indigenous courage, intelligence, determination, creativity, and artfulness. Indigenous survivance, therefore, is not simply surviving the centuries of harm by settler colonialists; rather, it is active resistance through critical consciousness and radical healing. (Sun et al., Reference Sun, Goforth, Nichols, Violante, Christopher, Howlett, Hogenson and Graham2022, p. 713)
Notably here, Sun et al., positioned radical healing as mediating the relationship between colonial harms and survivance as active resistance. Upholding active resistance as the outcome of interest, achieved through the process of healing, represents an organizational shift away from Euro-American models of wellness, which typically begin with exposure and conclude with the achievement of health in a linear sequence (Lavallee & Poole, Reference Lavallee and Poole2010). This is in stark contrast to many Indigenous approaches to wellness that conceptualize holistic well-being as cyclical, such as along a life journey that emerges from the dependencies of infancy only to return to the dependencies of old age (Gone, Reference Gone2011). Thus, while healing itself is represented in the abstract, its role in the process of resistance and survivance is clearly articulated.
Another pattern identified in papers that used the concept of healing in relation to survivance broadly was the grouping of healing alongside other desired outcomes. Manuelito (Reference Manuelito2015) engaged healing in association with survivance in this way:
They are not simply personal first-hand accounts about individuals who have been wounded, traumatized, and victimized by colonialism, racism, and sexism, but they are “living breath” from Native people who are engaged in Indigenous survivance, healing, and hope in multiple and complex ways. (Manuelito, Reference Manuelito2015, p. 2)
In instances such as this, narrative shifting is presented as a collection of improvements, of which survivance, healing, and hope are related but distinct outcomes.
Clear Examples of Health (n = 3). While general references to health or healing in relation to survivance were the norm within these papers, a few of the works that met inclusion criteria either reported or hypothesized more concrete relationships or pathways between health, healing, or wellbeing and narratives of survivance. Such is the case with the article by Ramirez and Hammack (Reference Ramirez and Hammack2014), which associated psychosocial stress with narratives of pathology and poor health, and narratives of survivance with improved well-being and the development of resilient identities. For their participants, these authors observed that “…they have adopted a narrative of survivance, which appears to buffer psychosocial stress and provide a resilient narrative identity” (Ramirez & Hammack, Reference Ramirez and Hammack2014, p. 112).
While the idea of buffering implies protection from the ill effects of deficit-focused narratives, other works identify alternative ways in which narratives of survivance may work to support healing:
…with each new conversation as well as each new archive, I confront the pain and joy of our Pueblo’s survivance. However, the testimonios of sobrevivencia sustain, motivate, and heal me in the process … as Indigenous Peoples, our individual and collective survivance and refusals of these so-called traumas are immensely valuable and important. (Urrieta, Reference Urrieta2019, p. 2)
Here, Urrieta (Reference Urrieta2019) suggested that healing may be achieved through the confrontation of narratives of colonial traumas, leading to recognition of not only pain but also strength, joy, and collective identity.
Wieskamp and Smith (Reference Wieskamp and Smith2020) offered a slightly different take, suggesting that altered narratives are themselves both the outcome of the healing journey as well as a pathway through which healing, alongside tradition and community, may be attained:
…survivance asserts the importance of narrative as a form of healing… Narratives of survivance respond to trauma by creating space for healing, tradition, and community… [and] underscore narratives’ potential for healing, indicating survivance’s relevance to this particular issue. (Wieskamp & Smith, Reference Wieskamp and Smith2020, p. 83)
While authors in this collection identified shifting narratives as contributing to survivance in relation to health and well-being in a diversity of ways, the association nevertheless emerged as salient in more than half of papers reviewed.
Temporality (n = 13)
Authors who are engaged in health scholarship that incorporated the idea of survivance also appeared to find particular salience in the concept of temporality, which occurred in three related but distinct ways. The first highlights the intergenerational nature of healing, the second engages the temporal process, while the third relates to the period in history on which mainstream discourse around Indigeneity often centers. Underlying all three lies the recognition that the present is both a reflection of the past and the basis for the future: “Paradoxically, with respect to most things Indigenous (whether cultural, epistemological, or therapeutic), to look forward is also to look backward so as to trace lines of continuity and to harvest insights from histories of both subjugation and ‘survivance’” (Gone, Reference Gone2016, p. 315).
Intergenerational Nature of Healing (n = 8). Survivance, as it appears within these papers, is intergenerational in nature; active survival is continuous, and resistance is enacted across generations. This focus underscores the importance of relationships in many Indigenous cultures, both with ancestors and descendants but also with historical narratives as a means of identity formation and meaning-making. Authors in this collection similarly perceive healing to be an intergenerational process, suggesting that actions taken in the name of healing, particularly from traumas of the past, should be undertaken in the name of future generations:
…one of this generation’s challenges that require “retracing” our ancestral knowledge and gathering traditional knowledge to mobilize culture as resistance to the survival of suicide and ultimately "survivance" of this generation and coming generations. (Danard, Reference Danard2016, p. iii)
Similarly, Jacob et al. (Reference Jacob, Gonzales, Finley and RunningHawk Johnson2019) stated that practicing survivance includes the articulation of “an intergenerational vision for well-being, which respects the past, takes responsibility in the present, and makes it possible for the future generations to have a better future” (Jacob et al., Reference Jacob, Gonzales, Finley and RunningHawk Johnson2019, p. 9). The temporal continuance across generations and the importance of this perspective and sustained relationships occurs again by Carter (Reference Carter2015), who described:
…life-affirming act[s] that connect the fallen ancestor, the current survivor, and the future descendant in a ceremony of mourning and a celebration of Indigenous endurance… herein lies the alchemical difference between grief spoken into spectacle and the private speech act that engenders healing… (Carter, Reference Carter2015, p. 419)
Temporal Process (n = 4). The continual nature of survivance emerged as an important subtheme in relation to processes of healing, specifically from historical or contemporary traumas. Authors noted that healing from such traumas is rarely linear, and rarely complete. The recognition of survivance as a continual process may function to reduce pressure to achieve health in accordance with a predetermined timeline. Wieskamp and Smith (Reference Wieskamp and Smith2020) elaborated this in relation to processes of healing from sexual violence and structural oppression:
Survivance’s emphasis on survival as a continuous process also disrupts the typical trajectory of trauma imagined in Euro-American discourse… in contrast, survivance blurs this timeline with its emphasis on constant renewal… Survivance’s avoidance of linear narratives is particularly useful because trauma is rarely experienced as such…it offers a dynamic space for resisting the colonization that exacerbates sexual violence and other forms of structural oppression by emphasizing ongoing renewal as process of healing. (Wieskamp & Smith, Reference Wieskamp and Smith2020, p. 77)
Period in History (n = 2). Finally, authors in this collection identified the importance of survivance in interrupting static cultural perceptions aligned with dehumanizing colonial narratives, as noted by Stephens (Reference Stephens2009), who stated, “Gerald Vizenor’s unique articulation of survivance is a response to the freezing of Aboriginal people in the myths and discourses of the western mind as ‘Indian’” (Stephens, Reference Stephens2009, p. 195). Similarly, Wieskamp and Smith (Reference Wieskamp and Smith2020) observed that the “…infinitive temporality challenges…the vanishing race myth and the traumatological timeline” (Wieskamp & Smith, Reference Wieskamp and Smith2020, p. 80). Further, authors noted the incongruity of lineal colonial narratives of Indigenous history that present a simplified trajectory and linear models of trauma that provide a singular narrow pathway from exposure to recovery. This is exemplified by Wieskamp and Smith (Reference Wieskamp and Smith2020):
First, the “infinitive,” or variable, temporal imaginary of survivance challenges linear narratives of the vanishing race myth and the traumatological timeline – a temporal imaginary that assigns a linear trajectory to the experience of trauma. Survivance asserts Native presence and unsettles distinction between past and present by refusing to settle in one particular tense. (Wieskamp & Smith, Reference Wieskamp and Smith2020, p. 74)
Community (n = 11)
The role of community emerged as a key theme within many of the works included in the scoping review. Community was perceived as essential both in relation to strength through collective identity, history, and knowledge, as well as collective rather than individualistic perspectives.
Strength in Community (n = 8). Strength in community, within this context, lies not only in collective existence but in shared history and cultural knowledge, the continued presence of which is a key element of survivance literature. “Instead of focusing on deficit, survivance allows for recognition of the exceptional, the remarkable, the strengths of communities” (Henry, Reference Henry2019, pp. 31–32).
Survivance draws on communal registers of wisdom and well-being for its central tenets … the centrality of interconnectedness to Indigenous life, the importance of sharing, and how individuals can draw strength from the community in times of hardship or plenty. (Phillips, Reference Phillips2018, p. 354)
Indeed, the presence of positive narratives bolstered through community cohesion was identified as beneficial for the promotion and maintenance of well-being even outside of formal health service provision:
…continued community closeness, caring, and compassion in the face of coloniality – the American Indian community can affect addiction not only through programmatic service provision but also through relationality expressed and experienced beyond the institutional boundaries that often harbor representations and paradigms that continue to work against American Indian peoples. (Henry, Reference Henry2019, pp. 50–51)
While community strength through implicitly shared culture and history was clearly identified as a component of survivance with the potential to positively impact health, the physical act of sharing cultural teachings either through storytelling or engagement in cultural practices was identified as a means of health promotion. Hedlund (Reference Hedlund2020) noted this in relation to survivance and decolonization at a community-wide level:
Yakima scholar Michelle M. Jacobs describes cultural survivance as an essential part of decolonization and argues that taking part in Indigenous social movements, community building, and cultural practice are intrinsic parts of healing historical trauma. (Hedlund, Reference Hedlund2020, p. 63)
Jacob et al. (Reference Jacob, Gonzales, Finley and RunningHawk Johnson2019) identified a similar pattern in relation to Indigenous college students and their navigation of the educational system:
…despite odds stacked against healthy Native American students at the university, we indeed see courageous students drawing from their own communities’ cultural teachings… (Jacob et al., Reference Jacob, Gonzales, Finley and RunningHawk Johnson2019, p. 11).
Collectivism (n = 8). One of the strengths of community noted frequently within this collection was the importance of a collectivist, rather than individualistic, perspective in relation to health and healing. As Wieskamp and Smith (Reference Wieskamp and Smith2020) stated, “Survivance is not solely based upon how an individual survives, but how a community survives” (Wieskamp & Smith, Reference Wieskamp and Smith2020, p. 77). This is particularly important for marginalized communities who may draw collective strength from narratives of survival. This idea is engaged in Ramirez and Hammack (Reference Ramirez and Hammack2014) who observed, “…resilience is not an individual trait; it is embodied in a collective narration of survival and generative social expression in the face of marginalization” (Ramirez & Hammack, Reference Ramirez and Hammack2014, p. 129).
Wieskamp and Smith (Reference Wieskamp and Smith2020) further elaborated that investing in or reengaging with community acts through narrative shift to decolonize perceptions of trauma and facilitate healing for Indigenous women:
Survivance’s potential for representing and community building makes it a particularly productive rhetoric for challenging dominant Euro-American narratives of trauma, which often emphasize individualism, disempower women, and exclude the experiences of Native women and other women of color… (Wieskamp & Smith, Reference Wieskamp and Smith2020, p. 75)
Decolonization (n = 11)
Decolonization as a key theme emerged independently from its association with earlier discussed subthemes. Decolonization in these papers consists of recognizing and prioritizing the benefits of traditional practices, those not considered by mainstream American culture to be affiliated with health as well as those traditionally associated with healing. This turn to tradition can entail the reengagement, and even revitalization, of long-subjugated Indigenous practices. The extrication or disentanglement of Indigenous narratives and life trajectories from colonial expectation is a concept integral to that of decolonization of therapeutic intervention (Gone, Reference Gone2021a).
Reclamation of Traditional Practices (n = 9). Authors highlighted the importance of revitalization or reengagement with traditional practices lost to colonization as a means of decolonization and an act of survivance and health promotion. Ka’opua et al., (2019) stated this succinctly, writing that the “promotion of Indigenous culture, traditions, and language are critical to community healing and prevention” (Ka’opua et al., Reference Ka’opua, Friedman, Duncombe, Mataira and Bywaters2019, p. 6). The importance of reengagement was poignantly noted in relation to reducing the risk of suicidality by Danard (Reference Danard2016), with:
…one of this generation’s challenges that require “retracing” our ancestral knowledge and gathering traditional knowledge to mobilize culture as resistance to the survival of suicide and ultimately “survivance” of this generation and coming generations. (Danard, Reference Danard2016, p. iii)
This subtheme was further supported by Hedlund (Reference Hedlund2020), who noted, in her study of decolonization, identity formation, and ceremony, that:
…by accessing toolboxes of Indigenous storytelling and cultural wealth and revitalizing them for contemporary cultural and political purposes, Indigenous individuals can become ‘Postindian warriors’, architects of survivance. (Hedlund, Reference Hedlund2020, p. 63)
They ultimately found that, within their study, “Nearly all participants shared… experiences of eventual adult reconnection to their cultural heritage, traditions, and spirituality” (Hedlund, Reference Hedlund2020, p. 67). Such benefits may come from what Manson and Buchwald (Reference Manson and Buchwald2021) identified as “…recapitulating a way of life that nourishes Indigenous ways of knowing, this time extended by lessons from a contemporary pandemic” (Manson & Buchwald, Reference Manson and Buchwald2021, p. 60).
Benefits of Traditional Practices (n = 5). In addition to the reclamation of traditional practices broadly, authors noted the value of traditional medicinal practices as well. The health benefits of engaging in traditional cultural practices around health and healing include elevated well-being (Pham et al., Reference Pham, Pomerville, Burrage and Gone2022), a reduction in substance misuse (Carr et al., Reference Carr, Chartier and Dadgostari2017), and improved physical health (Beltran et al., Reference Beltran, Schultz, Fernandez, Walters and Duran2018). These approaches may be most cogent for practitioners looking to improve well-being of populations who have experienced colonization. Indeed, Drees (Reference Drees2010) identified the benefits of incorporating traditional approaches to healing alongside mainstream treatments: “[Elder memories] illustrate the value of Indigenous medical practice and its significance to First Nations’ survival and ‘survivance’ alongside the government hospital and its medical staff” (Drees, Reference Drees2010, p. 182).
Danard (Reference Danard2016) went a step further to identify a specific traditional element, the medicine wheel teachings (a key element of pan-Indian perceptions of holistic well-being) as beneficial for suicide prevention:
Through analyzing literature, and reviewing various suicide prevention and healing and wellness approaches that center traditional cultural knowledge and documents and describe the medicine wheel teachings, the praxis is considered a promising practice for knowledge mobilization that visions community sustainability, stability, and survivance. (Danard, Reference Danard2016, p. 17)
While engagement in traditional medicinal practices as a means of decolonization and survivance for health promotion may be the most apparent application, other authors identified engagement in other traditional practices to be a form of decolonization and a means of improving wellbeing. These took the form of direct recommendations for health interventions, such as Danard (Reference Danard2016), who stated that a “…deeper understanding of traditional knowledge [is] a sustainable long-term approach to surviving suicide-strengthening life promotion and survivance” (Danard, Reference Danard2016, p. 18). Moreover, Hedlund (Reference Hedlund2020) wrote:
A number of studies show that community-based treatment that incorporates cultural and spiritual practices is particularly useful for addressing the deep-seated damage continually inflicted on Indigenous peoples by colonial processes. (Hedlund, Reference Hedlund2020, p. 64)
Other articles offered broader suggested applications, including the use of traditional dance to promote healing:
Culturally grounded community responses throughout the COVID-19 pandemic exemplify the ongoing survivance of First Nations people, communities, cultural practices, and histories… during the COVID-19 pandemic, dancers across the country continue this practice as they dance to pray for healing and protection for their people and communities. (Rowe et al., Reference Rowe, Rowat and Walker2020, p. 92)
Additional approaches include the education of youth around culture, place-based knowledge, and values as a means of bolstering pride in Indigenous identity, and harnessing the healing afforded by such approaches:
To promote Indigenous children’s survivance during middle school, results from our study highlighted the importance of active resistance against colonial scripts and reclaiming and celebrating Indigenous identity through embedding protective factors in SEL [social-emotional learning], such as the sacred culture, lands, and traditional values. (Sun et al., Reference Sun, Goforth, Nichols, Violante, Christopher, Howlett, Hogenson and Graham2022, p. 713)
Sovereignty (n = 10)
Among the key themes, sovereignty was the least frequently stated explicitly, but could nevertheless be perceived as integral to the realization of health survivance via each of the four other themes. Most notably in direct relation to well-being, sovereignty emerged as integral at a policy level to improve health. Carter (Reference Carter2015) highlighted this, writing, “Nor can we entrust our healing to a foreign government… but we can commit ourselves to and devise the interventions that will carry us from survival to survivance” (Carter, Reference Carter2015, p. 429). The utility of this assertion was supported by Rowe et al. (Reference Rowe, Rowat and Walker2020), offering a direct example related to tribal responses to the COVID-19 pandemic: “…by taking control of COVID-19-related responses, pandemic planning, and data, First Nations demonstrate survivance in asserting sovereignty and self-determination” (Rowe et al., Reference Rowe, Rowat and Walker2020, p. 90).
Agency (n = 10). Ingrained within Indigenous sovereignty was the concept of agency, which emerged most often indirectly in relation to prior themes of narrative, temporality, community, and decolonization. In most instances, agency was associated with the act of practicing sovereignty or overcoming adversity, as for Ramirez et al., (2014): “The generative social practice of these men described an agency in overcoming the historical legacy of colonialism” (Ramirez & Hammack, Reference Ramirez and Hammack2014, p. 129). This was true even when not explicitly named, as for Sun et al. (Reference Sun, Goforth, Nichols, Violante, Christopher, Howlett, Hogenson and Graham2022): “Indigenous survivance has also included challenging the existing social and political structures through antiracism and anti-colonialism to support their children’s identity development” (Sun et al., Reference Sun, Goforth, Nichols, Violante, Christopher, Howlett, Hogenson and Graham2022:699).
Empowerment (n = 5). Authors within this collection identified empowerment as occurring through agency and sovereignty, as Ramirez and Hammack (Reference Ramirez and Hammack2014) demonstrated:
Despite facing considerable oppression throughout their lives, these men are not merely subjects or a legacy of social and cultural oppression. Their narratives often highlighted their development of agency to empower their community and define their tribal identity. The development of agency is all the more salient as members of a nonfederally recognized California tribe because such groups lack access to the resources that come with federal recognition. (Ramirez & Hammack, Reference Ramirez and Hammack2014, p. 127)
Empowerment is then implicated in the process of healing from colonial trauma as “the generative social practice of these men described an agency in overcoming the historical legacy of colonialism” (Ramirez & Hammack, Reference Ramirez and Hammack2014, p. 129).
Discussion
First appearing in the health literature in 2009, the frequency of survivance has increased in recent years, with a sizeable proportion of publications consisting of doctoral dissertations by Indigenous scholars. Such engagement with the term may indicate that those early in their careers are increasingly identifying with survivance over other similar terms, such as resilience. Also notable is the diversity of disciplines represented within the corpus. While all 32 publications included texts broadly centered on health or wellbeing, the absence of works from mainstream medical disciplines is notable, as is the inclusion of disciplines not typically considered to engage with topics of health (e.g., religion and geography). This may be in keeping with Indigenous perceptions of welbeing, which are more expansive than Euro-colonial definitions of health.
Survivance first emerged within Indigenous contexts, and it is therefore unsurprising that the majority of papers within this review engaged the term in relation to Indigenous populations. However, some publications included African American populations or extended beyond North America. Thus, the term appears to resonate broadly with populations experiencing legacies of oppression. Finally, most of the works analyzed here were theoretical or explanatory and without clear measurement of survivance or reproducible methods, with broad reference to healing being the most common outcome of interest. The term, therefore, appears to be quite promising, with clear indications of interest and useability as well as diverse applicability, but currently lacks consensus around definition and measurement.
Despite the diversity of disciplines employing the term, general consensus emerged on key elements of health survivance: narrative, temporality, community, decolonization, and sovereignty. Narratives of health were largely universal within the corpus, but were employed in a variety of ways, including as a mediator or outcome, with few works providing clear pathways through which narrative impacted health. Temporally, there was shared recognition that the present reflects the past while serving as a basis for the future, and that colonially defined historical narratives of deficit and pathology were motivated by othering and erasure.
Healing was understood as occurring across generations, with an emphasis on expanding healing and wellness timelines. Community emerged as strength in collective identity, while decolonization highlighted the benefits to health and well-being of engaging in traditional medicinal practices as well as reclaiming nonmedicinal traditional activities. Finally, sovereignty, through agency and empowerment, ran through all other themes and was implicated in the process of healing from past colonial harms. In sum, agency and associated sovereignty afford the means to transition from a state of survival, a reactive state, to one of survivance, a proactive state.
Rearticulations of Vizenor’s survivance
As a postmodern literary scholar, Gerald Vizenor’s texts are dense and at times elusive. For 30 years his prose has provoked thought and established literary movements that have overflowed enthusiastically into adjacent disciplines. Despite the widespread adoption of many of his concepts, including manifest manners, postindianism, and of course survivance, by nature, these ideas resist narrow definition and elude formal measurement. As such, it is perhaps not surprising that the most common Vizenor quote utilized by authors in this collection to define survivance comes from one of his most popular books on survivance, Manifest Manners: Narratives on Postindian Survivance, and occurs on the very first page of the preface. Here, Vizenor stated that “Survivance is an active sense of presence, the continuance of native stories, not a mere reaction or a survivable name. Native survivance stories are renunciations of dominance, tragedy, and victimry” (Vizenor, Reference Vizenor1999, p. vii).
Remarkably, despite Vizenor’s emphasis on Native survivance through literary means and a postmodern lens, scholars engaging with issues of health and wellbeing have identified value for the term within various physical, psychological, and spiritual arenas. Despite clear enthusiasm for engaging with the term, authors utilizing survivance with reference to health applied it with varying degrees of adherence to Vizenor’s original conception. Perhaps the most obvious areas of overlap – as well as divergence – are in the adoption and application of narrative and temporality. Vizenor wrote about survivance occurring through the repudiation of manifest manners of domination – such as the vanishing race myth and static state referenced by authors in this scoping review – by postmodern vivancy (Vizenor, Reference Vizenor1999).
While authors largely adhered to Vizenor’s usage of survivance as “elusive, obscure, and imprecise” (Vizenor, Reference Vizenor2008, p. 1) some health researchers applied the term more concretely, identifying specific mechanisms such as the buffering of psychosocial stress or the recognition of intergenerational strength and collective identity, as avenues through which narrative shift promoted health through survivance. Additionally, while Vizenor’s survivance occurs via the upending of manifest manners through unsettling colonial racist tropes (temporally situated within the “premodern”), authors applying survivance to health largely focused on narratives of health in the present and in relation to historical trauma, pathology, and traumatological timelines.
Community, as applied by scoping review authors, was associated with survivance via strength through collective identity, history, and knowledge, particularly in response to continuous colonial affronts. This framing aligns with Vizenor’s original conception of survivance. “Native American Indian identities,” he says, “bear the tribal memories and solace of heard stories… The sources of tribal remembrance, tragic wisdom, creation, personal visions, and the communal nature of the heard are precarious, [but are] burdened more with colonial discoveries, duplicities, and simulations in the literature of dominance than with the menace of silence, the inaccuracies of memories and histories” (Vizenor, Reference Vizenor1999, p. 52). Thus, survivance, both literary and therapeutic, may occur through shared memories and history, including stories of overcoming and thriving in the face of physical, cultural, and spiritual assaults.
Regarding the theme of decolonization, scoping review authors intimated that healing and well-being might best be approached through traditional practice. While Vizenor does engage with tradition in his works on survivance, saying that the nature of survivance is unmistakable in native stories and traditions (Vizenor, Reference Vizenor2008), he is more concerned with active presence and the postindian, the “chance of totemic associations, conversions, and reversions of tribal cultures, as postmodern survivance and vivancy” (Vizenor, Reference Vizenor1999, p. viii). Thus, while postindian health may occur through engagement or reengagement with traditional culture, Vizenor’s survivance does not place the same emphasis on tradition as do the health survivance publications.
Almost by definition, the scoping review themes and subthemes of sovereignty, agency, and empowerment are inherent in Vizenor’s conception of survivance, as “active resistance and repudiation of dominance” (Vizenor, Reference Vizenor1999, p. 11). Indeed, within the scoping review papers, health survivance was frequently enacted through active resistance toward inequitable health policies and the repudiation of dominant narratives of inherent Indigenous pathology. On this theme, unlike most others, the authors appear to directly apply Vizenor’s practice of survivance to the concept of health.
Invocations of Indigenous historical trauma
For both Vizenor and the authors in this scoping review, survivance was re/presented as the counterpoint to legacies of colonial subjugation or what has come to be known in the health sciences as historical trauma (Brave Heart et al., Reference Brave Heart, Chase, Elkins and Altschul2011; Kirmayer et al., Reference Kirmayer, Gone and Moses2014). Vizenor explained, “Manifest Destiny would cause the death of millions of tribal people from massacres, diseases, and the loneliness of reservations. Entire cultures have been terminated in the course of nationalism. These histories are now the simulations of dominance, and the causes of the conditions that have become manifest manners in literature” (Vizenor, Reference Vizenor1999, p. 4). Indeed, 78% (n = 25) of scoping review publications explicitly associated health survivance with historical trauma or similar terms such as traumatic past or historical experiences and oppression.
Colonial injury, it would appear, is recognized as implicit in the very concept of survivance across its multidisciplinary usage when addressed to health concerns. Interestingly, experiences of historical trauma are claimed to differ from acute traumas (while not precluding their co-occurrence) through what is colloquially referred to as the “4 C’s” of historical trauma (Hartmann & Gone, Reference Hartmann and Gone2014): colonial injury, collective experience, cumulative effects, and cross-generational impacts. As a result, historical trauma theory is deeply entrenched in shifting the narrative surrounding Indigenous health and wellbeing within both research and practice.
As summarized by Gone (Reference Gone2021b), historical trauma theory provides an explanation for the pervasiveness of health inequities experienced by Indigenous communities while situating the blame within historical and structural contexts, thereby destigmatizing individual suffering through shared pain and collective recovery. It provides legitimacy for traditional therapeutic practice and reconciliation, takes advantage of attention and resources allocated to population health, and works to decolonize health fields through the contributions of Indigenous pieces of knowledge. Survivance, in its original narrative form, fits neatly into existing historical trauma models, including Mohatt et al.’s, Reference Mohatt, Thompson, Thai and Tebes2014 model, which illustrates how community narratives of historical traumas frame contemporary reminders of past events and help to develop collective memory and identity (Mohatt et al., Reference Mohatt, Thompson, Thai and Tebes2014). Additionally, it reinforces longstanding Indigenous models of holistic well-being rather than linear health, often demonstrated through images like the medicine wheel (Pomerville & Gone, Reference Pomerville and Gone2019).
The results of this scoping review demonstrate that these characteristics are mirrored within scholars’ application of survivance in addressing health concerns: the emphasis on shifting narratives from those of pathology to those of continued presence, the recognition of community strength and identity as a means of collective recovery, and engagement in traditional therapeutic and cultural practices as a means of interruption and healing, all undertaken as expressions of Indigenous sovereignty, agency, and empowerment. These qualities also afford insight into Indigenous discontent with the original concept of conventional resilience, which emphasizes individual pathology, lifespan development, and responsibility for healing despite the structural origins of colonial harms. Survivance instead captures community and cultural processes that have been shaped by shared experiences of the past and the present, while focusing temporally on the future, in the lives of collectivities more so than of individuals. Thus, while the concept of resilience has demonstrated merit within some populations and situations of adversity, it is perhaps inadequate within the context of Indigenous experiences of historical and ongoing colonial subjugation.
Efforts to develop a unique “Indigenous resilience” risk diverging so far from conventional definitions as to become functionally unique, requiring regular clarification and contextualization. Indeed, scholars who employ the concept of Indigenous resilience at times have in the past called for a concept in line with survivance, as Hatala and colleagues (2016) did when stating:
…there is a need to bolster the narrative of – and research around – a strengths-based concept of resilience to counteract the potentially negative implications of historical trauma narratives that can frame [Indigenous] health issues within a narrative of pathology, victimization, and disparity… we suggest a movement toward the establishment of a plurality of perspectives, where resilience and historical trauma hang together as multiple overlapping voices” (Hatala et al., Reference Hatala, Desjardins and Bombay2016, p. 1912).
Survivance, with its inclusive definition and community and cultural focus, appears to be a potential answer to these calls and is emerging within the health field as an alternative (or alter-Native) concept that better captures vibrant responses to Indigenous suffering when compared to the term resilience, particularly in relation to historical trauma. In fact, based on this scoping review, we propose the following analogy: as resilience is to trauma, so survivance is to Indigenous historical trauma. Indeed, this analogy illuminates the scholarly potential of survivance to potentially enable further contextualization of postindian states of wellbeing within settler colonial existence and continued Indigenous active presence.
Limitations
There were a number of limitations to this scoping review. As an initial exploration of an emerging topic, data were extracted on country and general population. Future studies should explore the use of survivance in relation to health for specific tribal nations, cultures, or populations. Another limitation was the lack of a comprehensive thematic analysis by a second reviewer (although the senior author did review all findings, he did not perform an independent qualitative analysis of the content). More importantly, the conceptual relationship between resilience and survivance with respect to lifespan development was difficult to ascertain and represent from this corpus.
This was true because development as such was not a prevalent theme in this corpus, so there was little “data” to draw on for analytic purposes. Moreover, while lifespan development is driven by normative biological changes over time for individual organisms, the kinds of diachronic changes associated with survivance are principally sociocultural and intergenerational. Such extra-organismic shifts imply different sociological dynamics for which the language of development (owing to its entanglement with discourses of primitivity and societal evolution) would not be appropriate in the Indigenous context. In the future, researchers should attend to this still murky conceptual intersection of resilience and survivance with respect to the important domain of lifespan development.
Finally, the concept of well-being is complex for all peoples, but perhaps particularly so for Indigenous populations. While reviewing papers for inclusion in this work we included only those documents that met a narrow definition of health and wellbeing. This resulted in the exclusion of a number of papers that approached wellbeing from a broader perspective, including those focused on human-environment wellbeing and identity and cultural wellbeing. It is perhaps likely that diverging from the narrow definition of health included here would result in the inclusion of additional papers that may adhere to perceptions of well-being in line with Indigenous ways of knowing. We recommend that future work expand definitions of health and well-being to include these additional avenues of inquiry.
Conclusion
It is evident that Indigenous health researchers recognize the value of survivance and are increasingly applying it within their work. Across vast disciplinary divides, methodologies, and emphases, scholars employing survivance in relation to health shared thematic elements of narrative, temporality, community, decolonization, and sovereignty in a manner that perhaps portends future consolidation of the term within the Indigenous health vocabulary. This will likely occur in association with Indigenous historical trauma, which is already a key tenant of behavioral and physiological Indigenous health research and practice. Given the integration of understandings of historical and structural factors pertaining to health and its emphasis on community strengths rather than deficits, survivance serves as a companion concept to historical trauma in a manner that was not previously served by resilience.
The continued development of survivance as a concept in Indigenous health provides opportunities to expand beyond the limitations of resilience in ways that support positive identity formation and the prevention of despair, particularly for Indigenous youth and communities who are engaging in cultural revitalization. In the end, despite Vizenor’s original assertion that “survivance is a practice, not an ideology, dissimulation, or a theory” (Vizenor, Reference Vizenor2008, p. 11), there may be value in investing in further operationalization of survivance for health research and practice through the development of a united definition and associated measurement tool. This would ensure comparability across studies and health promotion interventions, and would support future strengths-based Indigenous health research. A formal definition and scale would also facilitate the generalizability of the concept to other populations experiencing enduring legacies of oppression.
Acknowledgments
The first author would like to thank Vivette Jeffries-Logan for guiding her thinking around the use of resilience in relation to Indigenous experiences of historical trauma.
Funding statement
This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The authors have no conflicts of interest to report.
