Sumud: The Arabic Concept of Steadfastness Reshaping How Psychiatry Understands Resilience

For decades, psychiatry has measured resilience as if it lived inside a single person: a bundle of personal traits, coping skills, and the capacity to bounce back after adversity. A new systematic review argues that this individualistic lens misses something fundamental in cultures where endurance is a shared, moral, and relational practice. The review, published in Frontiers in Psychiatry, examined sumud — an Arabic word broadly translating as steadfastness, perseverance, and endurance — and found that it functions as a multilevel, collective form of resilience sustained through families, intergenerational stories, cultural practices, and institutions. Across 39 studies, the researchers concluded that sumud challenges the dominant psychiatric framework and offers clinicians a culturally embedded model for understanding how people survive chronic adversity with dignity intact.

The research team, led by Dina Aly El-Gabry and Iffat Elbarazi of United Arab Emirates University alongside colleagues in Egypt, Canada, and Dubai, conducted a PRISMA 2020-guided systematic narrative review registered with PROSPERO. They searched four databases — PubMed, Scopus, Web of Science, and Embase — for English-language studies that explicitly examined sumud as a cultural, psychological, or collective construct relevant to resilience, coping, or psychotherapy. The initial screening of 178 raw records, reduced to 111 unique entries after deduplication, yielded 37 included studies; a rapid update search on 1 June 2026 added two more, bringing the final synthesis to 39. Eligible publication types ranged from qualitative and quantitative empirical studies to ethnographies, narrative analyses, theoretical papers, and reviews, all thematically synthesized using a predefined extraction matrix.

What emerged from the synthesis is a concept far richer than simple persistence. Scholars distinguish between tangible sumud — the material infrastructures that sustain daily life, such as schools, healthcare services, community organizations, and informal social networks — and intangible sumud, encompassing belief systems, religious and spiritual values, cultural identity, social cohesion, and strong family support. Together these intertwined dimensions function as protective resources aligned with social-ecological perspectives in resilience research. Conceptually, researchers also differentiate passive or static sumud, centered on remaining rooted and maintaining continuity, from dynamic sumud, which involves everyday acts of moral agency and efforts to preserve dignity and coherence under restrictive conditions.

The review’s technical contribution lies partly in a structured comparison that sets sumud apart from adjacent constructs. Coping, the authors note, is more technical and often individual and strategy-based. Resilience presupposes recovery and restoration of functioning. Stoicism is primarily philosophical and individual. Resignation is passive and lacks agency. Endurance alone does not sufficiently account for meaning, identity, and sociopolitical context. Sumud, by contrast, is oriented toward collective endurance rather than individual adaptation, persistence in the absence of equilibrium rather than a return to it, and the capacity to hold on rather than to bounce back. Crucially, it presupposes conditions under which resolution is not imminently available — a temporal dynamic that distinguishes it from Western models that implicitly assume adversity is time-limited.

At the psychological level, the reviewed studies linked sumud to meaning-making, emotional regulation, self-awareness, hope, and perceived self-efficacy, but consistently described these capacities as relationally scaffolded rather than purely intrapsychic. Hope proved an interesting case: quantitative studies reported mixed findings on its direct association with resilience, while qualitative accounts underscored hope as embedded in shared narratives, ethical commitments, and future-oriented responsibilities. At the relational level, sumud was enacted through caregiving, mutual support, and intergenerational transmission of memory, with family systems described as primary sites through which resilience was sustained and transmitted. Quantitative work suggested that resilience could be maintained despite substantial stress exposure but was strongly associated with social connectedness, education, and community resources rather than individual characteristics alone.

Perhaps the most striking findings concern the body and culture. Studies documented sumud expressed through theatre, music, poetry, visual art, dance, sport, fishing, and communal food practices. The dabke, a group-based folkloric dance, was conceptualized not merely as cultural expression but as a re-embodied articulation of attachment and continuity, in which collective movement, synchrony, and circular formation enact rootedness and belonging even amid displacement. Palestinian parkour in Gaza was analyzed as embodied practice and land-based physical activity. Culinary traditions in diaspora communities, such as Palestinian cuisine remembered through Chilean kitchens, operated as sites of cultural continuity and relational resilience, reinforcing belonging and memory through shared routines. These activities functioned as collective psychosocial resources supporting continuity, identity, and belonging through participation, rhythm, repetition, and shared expression — integral components of lived resilience rather than ancillary coping techniques.

The review also delivers a critical caution that prevents the concept from becoming a romantic slogan. Ethical tensions and cumulative burdens were documented throughout the corpus, particularly for women, caregivers, and professionals. Feminist analyses highlighted everyday responsibilities, caregiving labor, and cultural transmission as central expressions of sumud while drawing attention to constrained choice and unequal distribution of labor within households. Studies of healthcare workers described professional endurance tied to ethical commitment and collegiality, but also documented dual-role burden, ethical strain, and cumulative professional stress. The authors warn that framing sumud purely as strength risks overlooking exhaustion, burnout, and the structural conditions that make endurance necessary — and that uncritical celebration may normalize suffering, reinforce expectations of self-sacrifice, and even discourage help-seeking where distress is understood through a framework of moral endurance.

Clinically, the review translates sumud into concrete psychotherapeutic principles rather than prescribing a new manualized protocol. The emphasis on continuity, narrative, and shared meaning resonates with narrative and family-based approaches, which conceptualize wellbeing as emerging through relational stories and intergenerational meaning-making. The collective nature of sumud supports group and community-based interventions built on interpersonal processes, collective witnessing, and normalization of shared experience. The prominence of embodied, cultural, and expressive practices aligns with arts-based and body-oriented psychotherapies. In cultural assessment, clinicians can routinely ask about sources of endurance, collective belonging, and moral obligation rather than confining intake to individual symptom inventories. In case formulation, distress presenting as persistent low mood under chronic, unresolved adversity can be provisionally understood as a rational response to sustained structural strain rather than solely as pathology. The authors also encourage clinicians to distinguish presentations of endurance and moral commitment from depressive withdrawal, since the two can be phenomenologically similar but carry different treatment implications.

Methodologically, the review acknowledges significant gaps. The dominance of qualitative, ethnographic, and conceptual work allowed rich cultural analysis but limited causal inference and systematic outcome evaluation. Rigorously evaluated, sumud-informed psychotherapeutic interventions remain scarce — the authors identify this near-total absence as the field’s principal priority. Longitudinal designs, mixed-methods approaches, and quantitative outcome measures were rare, and outcome measures often relied on individual symptom scales poorly aligned with collective resilience constructs. Geographic coverage was concentrated in Palestinian settings, with additional work in Lebanon, Turkey, Iraq, Syria, and diaspora communities, and restricting eligibility to English-language publications may have excluded relevant Arabic- and French-language scholarship. The authors recommend developing and validating a sumud-specific outcome measure, longitudinal cohort designs following families and professional cohorts, intervention-development studies piloting narrative, family-based, or arts-informed approaches explicitly grounded in sumud, and replication of the socio-ecological framework in other Arab and diaspora settings.

Situating sumud within broader scholarship, the review connects it to foundational critiques in transcultural psychiatry — including arguments that suffering and healing are shaped by local moral worlds rather than existing as culture-free biomedical facts, and cautions against treating culture as a superficial modifier of universal psychiatric categories. The authors also compare sumud with other non-Western, collectively oriented personhood concepts: Ubuntu, the Southern African ethic of mutual obligation oriented toward restorative justice; Buen Vivir, the Andean concept of collective wellbeing in balance with community and nature; and Kapwa, the Filipino concept of shared identity. Sumud belongs to this broader family of relational concepts while retaining a distinctive emphasis on dignified endurance under conditions where resolution is not immediately available. As ongoing conflicts and humanitarian crises continue to affect parts of the Middle East and Gulf region, the researchers argue that sumud warrants renewed scholarly and clinical attention as a culturally grounded framework for resilience-informed psychotherapeutic practice — one that engages patients’ relational worlds, cultural narratives, and collective practices while remaining attentive to the costs of endurance.

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Subject of Research: Sumud as a framework for collective resilience in transcultural psychiatry and psychotherapy

Article Title: Sumud as a framework for collective resilience: a systematic review of implications for transcultural psychiatry and psychotherapy

Article References: Aly El-Gabry, D., Elbarazi, I., Stip, E., Al Sheryani, R., Amiri, L., Okasha, T., & Dabbagh, N. T. (2026). Sumud as a framework for collective resilience: a systematic review of implications for transcultural psychiatry and psychotherapy. Frontiers in Psychiatry, 17, Article 1908428. https://doi.org/10.3389/fpsyt.2026.1908428

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1908428

Keywords: sumud, collective resilience, transcultural psychiatry, psychotherapy, systematic review, cultural psychiatry, global mental health, narrative therapy, family therapy, arts-based therapy, Middle East, meaning-making