In the years 1949 and 1950, the Chinese invasion of Tibet sparked years of hardship for Tibetans. This led to the overthrow of the Tibetan Government, the suppression of religious practices and the destruction of religious symbols, and the exile of His Holiness the 14th Dalai Lama along with over 100,000 Tibetans in 1959 [1]. In Tibet, thousands of monasteries have been destroyed, and many monks and nuns are prohibited from practicing Tibetan Buddhism without the government’s supervision [1]. Although the Chinese government signed the Convention Against Torture Act in 1986, they have repeatedly violated human rights [2]. 1.2 million Tibetans have been killed, and countless have been imprisoned and tortured for resisting Chinese rule and exercising their human rights [3]. Activities such as peaceful protests calling for a free Tibet and respect for human rights, putting up photographs of the Dalai Lama, singing Tibetan patriotic songs, or attempting to flee Tibet without permission from the Chinese government are grounds for arrest. Tibetans that have been imprisoned have described a number of methods of torture that they have endured. These include beatings, electric shock, sexual assault, starvation, solitary confinement, and other degrading acts [4]. 

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The violation of human rights by the Chinese government is recognized worldwide. In 1991, the UN Sub-Commission on Prevention of Discrimination and Protection of Minorities passed a “Situation in Tibet” Resolution, stating concern for “violations of fundamental human rights and freedoms that threaten the distinct cultural, religious and national identity of the Tibetan people” [5]. Despite the repeated violations imposed upon Tibetans, many studies have found low prevalence of psychological distress following these traumatic events. In comparison to other Asian refugee populations, the Tibetan population are found to have the fewest symptoms of post-traumatic stress disorder (PTSD) [6]. Tibetans in exile, specifically torture survivors, seem resilient to the traumatic experiences that have resulted from China’s invasion of Tibet. There are several cultural and religious factors that play a role in this resilience, but many cross-cultural studies may not accurately measure the level of psychological effects that Tibetans refugees undergo.

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Two studies conducted on the Tibetan refugee population in Dharamsala, India found no significant difference in rates of depression and somatization between torture survivors and other refugees [7] [8]. In a study done by Sachs, Rosenfeld, Lhewa, Rasmussen, and Keller (2008) on Tibetan refugees that had recently arrived to Dharamsala, symptoms of PTSD and depression were increased across categories of trauma exposure [4]. These categories range from low level of trauma (e.g., attempting to escape Tibet or being restricted from practicing Tibetan religion), other potentially traumatic experiences (e.g., having family members who were tortured, killed, or imprisoned for political reasons, direct experience of religious persecution, or experiencing maltreatment that is not defined as torture by the UN), or torture as defined by the UN. However, the prevalence of psychological distress was relatively low, even among torture survivors. Some reasons why prevalence is low for Tibetan refugees may be due to the exclusion of the resettlement process. The participants in the study may have been experiencing a state of relief and anticipation for or gratitude from meeting His Holiness the Dalai Lama [4]. A follow-up study should be conducted in order to investigate the long-term  influence of the hardships of refugee life on psychological distress. Furthermore, the participants, including torture survivors, made social comparisons in which they rated their experience as less severe than other Tibetans. This subjective appraisal, through comparison, may play a role in the low levels of psychological distress. In an interview with Tsewang, a Tibetan who was imprisoned for attempting to escape Tibet. She noted that her experience was not as bad as other Tibetans and she feels grateful and lucky for being where she is now [9]. She holds a similar subjective appraisal as the participants in the study, which helps her maintain a positive mindset. 

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Tibetans in exile may hold other subjective opinions on traumatic events. Studies have shown that Tibetans ranked religious persecution or destruction of religious symbols as the most traumatic experiences one can go through [1] [10]. These events differ from what other cultures may define as traumatic, and may cause more psychological distress to Tibetan refugees than other events. This may explain the low association between other traumatic events and psychological distress or symptoms of PTSD. In addition, Sachs et al. (2008) placed religious persecution in categories of less traumatic events, which contradicts the point of view Tibetans have on severity of these particular events [4]. This may provide inaccurate results in the study.   

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When conducting cross-cultural research, one must consider cultural sensitivity. The Tibetan population may not define or experience distress in the same manner as Westerners. Some studies have found that Asian populations tend to display psychological distress more somatically than Westerners [11] [12]. Somatic symptoms are symptoms related to the body. In a study conducted by Maaike, Margaret, and Rolf (2001), Tibetan refugees scored highest on items related to emotional distress that were somatically phrased [10]. This may explain the low prevalence of symptoms reported by participants in studies that fail to consider somatic effects. 

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Although the methods of cross-cultural studies may provide one explanation for the low prevalence of psychological distress in Tibetan refugees and torture survivors, many cultural and religious factors play a major role in the resilience of Tibetans in exile. Hussain and Bhushan (2011) found that Tibetans who have experienced traumatic events have low levels of psychological distress, and religious coping strategies appear as mediators for the psychological effects of trauma. These include the devotion and faith in the Dalai Lama, understanding of Buddhist philosophy and the law of karma, community bonding and support, and historical models that promote strength [13]. The Dalai Lama serves as a  spiritual and protective leader of Tibetan refugees. Tibetans believe that His Holiness is a reincarnation of the Buddha of Compassion and he is seen as a symbol of hope for Tibetans in exile. He also plays a large role in the cohesiveness and thrift of the Tibetan community. His Holiness has helped build a multitude of institutions and organizations that work to preserve Tibetan culture, traditions, and religion. These include the Tibetan Institute of Performing Arts to preserve a variety of Tibetan arts, the Tibetan Children’s Village which provides education for destitute Tibetan children, the Central Institute of Higher Tibetan Studies which is a university for Tibetans, and the Central Tibetan Administration which is the Tibetan government in exile.