21st Annual Convention of American Indian Psychologists and Psychology Graduate
Students Training Module Two: Current Issues in Tribal/Native Behavioral Health
Scientific Mindedness: Form and test hypotheses about a culturally different client’s
issues, rather than making premature conclusions about that client and his/her culture.
A Focus on Dynamic Sizing: Know when to generalize about certain behaviors and
when to individualize.
Culture-Specific Expertise: Develop a through understanding to the cultural groups
most prevalent in the marketplace. In some areas such as rural Washington this might
imply an understanding of cultural groups less prevalent on a national level and more
prevalent on a local level.
Disease Epidemics: Around 1790 as high as 80% of tribal peoples living in Washington/
Oregon died of smallpox, cholera, and other diseases of European origin. A second
major epidemic around 1820 occurred w/ an estimated 30 – 70 per cent native death toll1.
Treaties: Basis for sovereign status of tribes, legal protections of resource rights, and
health and educational benefits. Have a history of deceit, social scapegoating, loss of
independence, and failed promises. In exchange for restrictions on freedoms, unwanted
supervision, and unfulfilled promises of long-term rights and benefits, native people
made enormous concessions of resources and land have been made by native peoples.
Leads to feelings of persecution and mistrust by tribal people and blatant hostility on part
of non-natives resentful of Indian treaty rights.
Ethno-centric attitudes: Many Euro-Americans assumed that lifestyle, values, beliefs,
and institutions were superior and thusly, they had a manifest right to impose
“civilization” on tribal peoples.
Repeated Shifts in Federal Indian Policies: Anglicization through private property,
education, and religion (Hagen, 1966)2.
Systematic separation from lands – lack of understanding: tribe – belongs to land
– sacred trust – do not own, thus can’t sell
Privatization and confiscation of historically tribal lands
Reversal or sabotage of federal acts: uphold treaty rights
Late 1880’s pressure from settlers, gold issues, etc
In 1887 the Dawes Act or General Allotment Act
In 1934 Indian Reorganization Act
1 Probably smallpox
2 Hagen, T. The American Indian, 1966 p 121.
Between 1887 & 1934 lost over ½ of remaining treaty-based land and
resource holdings
Indian Reorganization & “New Deal”
1924 Citizenship – resulted from WW1 service record
1928 ‘Meriam Report” devastating effects of forced acculturation
1934 – The Indian Reorganization Act -> options grant not available before ->
during 1930’s and 1940’s land loss slowed down and self-determination/self-
governance increased
Termination & Relocation Policies of 1950’s
In 1950’s government attempted to end federal connection & responsibility
toward native people
Moved native people to the urban areas, but the assumption that tribal people’s
children would disappear into mainstream community unfounded3
Depression, isolation & alcoholism
Lump sums to end federal responsibility forever (only accepted by two tribes).
Public Law 83-280 allowed states to impose their civil and criminal laws on tribes
Tribal Resource Development and Self-Determination
By end of 1950’s Federal polices revised – ensure termination not forced on tribes
and steps taken to protect land rights & cultural heritage
In 1960’s reservation economic development emphasized
Population increase & lack or resources/infrastructure -> poverty and
unemployment
By end of 1960’s the Bolt decision about tribal fishing rights and Public Law 93-
638 “The Indian Self-Determination Act” favorably affected tribal status
Recent Trend in Federal and State Indian Policies
Periodic shifts have created unstable atmosphere
Despite generally conservative political climate, most tribal people believe that
3 The People Speak: Will You Listen? Report of the Governor’s Indian Affairs Task Force, 1973
self-determination (sovereignty) is on the rise
Indian Child Welfare
Removal of Indian Children from Families & Tribes.
The Indian Child Welfare Act, PL 95-608 was designed to stem the flow of
children from tribal homes and communities
In Washington State, the adoption rate for Indian Children was 19
times that of non-Indian children4.
Prejudice against Native lifestyle & lack of understanding of tribal family systems
and religious beliefs
Poverty – insufficient cause – lack of remedial alternatives – unethical practices
by child placement agencies, caseworkers, and special interest groups
Certain religious groups made special efforts to remove and “save” as
many tribal children as possible5.
Lead to the development of serious social & emotional difficulties – frustration,
confusion, and anger without a clear sense of cultural identity
Contributes to fear, suspicion & hostility of Native adults toward caseworkers and
other authorities
Lead to lost educational, health, fishing, enrollment, or other rights
In 1978, the federal Indian Child Welfare (ICW) Act
Unprecedented protection for Native children, families, and tribes
Jurisdiction, monitoring, establishing dependency or termination, & placement
preferences
Congressional appropriation of funds (i.e. remains inadequate)
Washington State Department of Health & Social Services have negotiated and
signed a statewide Tribal-State agreement for the provision of child welfare
services: affirms and strengthens the Federal Indian Child Welfare Act & changes
the parameters for involvement of the Washington State Children’s
4 Todd, Goldie Denny, “Indian Child Welfare,” in Indian and Alaska Native Mental Health Seminars,
Seattle Indian Health Board, 1982, p. 489.
5 The Mormon Placement Program, in the year 1993-1993 all (100%) of the clients I treated at the Salt
Lake City Indian Alcoholism Counseling – Recovery House Project had been placed with Mormon families
as children.
Administration with tribes
The Suppression of Indian Religion
Active persecution and ongoing misunderstanding of tribal religious practices
Multiplicity and subtle complexity
Christian missionaries used technological superiority
Many tribal people made public conversions but retained private
practice & belief in Native/Tribal spiritual and religious ways
In 1800’s Indian religion, spiritual practices, and healing were outlawed
Natives were fined & jailed – therefore – traditional practices went
underground
Tribal children were placed in boarding schools and developed a confused
perspective on tribal religious practices & beliefs – guilt about families and tribes
religious practices
Lead to losses of medical and healing knowledge -> thus Native
healing systems were also hurt by the attack on tribal religions
Despite pressures to abandon Native religions, many beliefs and practices have
continued, are taught, and affect the worldview of many tribal people
In 1978, The Indian Religious Freedom Act was passed, officially repealing the ban on
Indian religious beliefs and practices
Today, Natives are highly varied in their beliefs and practices: a slow and
cautious recovery of tribal religious practices was begun in the 1930’s & 1940’s
In the 1960’s and 1970’s, there was a burst of renewed interest in tribal/native
religious beliefs and practices
Typically, Tribal people are tolerant of other’s religious beliefs and practices –
there is much fragmentation in native communities
Education of Tribal Children as a Means of Forced Acculturation
Removal of Indian children to boarding schools
Policy of forced acculturation6
Physical punishment of Tribal cultural orientation (speaking native
languages, following Indian spiritual practices, etc)
Prohibiting even non-English speaking children from speaking their
own languages and using their native names
Teaching academic subjects to native children which bore no relation
to their experience or culture
Placing tribal children in residential schools dedicated to de-
Indianizing and Americanizing them
Separating children from the same tribe or who spoke the same
language
Forced separation of Indian children from their families and tribes
Forcing children to wear non-native clothing and hairstyles
Requiring participation in Christian religious practices
Native parents resisted and were denied food rations, often, native children were
forcibly removed or kidnapped7
The death rate of tribal children in BIA boarding schools was abnormally high8
Boarding schools were the major cause of the loss of tribal languages
Language is the primary carrier of culture, often ideas and concepts are not
translatable across languages, thus the attacks on tribal languages in BIA boarding
schools weakened native culture tremendously
Tribal children who did attempt to return to their culture had extreme difficulty
fitting in – delayed in their social and emotional development as native people
and a large number developed severe adult problems: alcoholism, depression, or
violent behavior9
A lasting consequence: upsurge in child neglect and cycle of removal of
successive generations of tribal children from their families10
In 1960’s authorities recognized a problem – BIA boarding schools still exist, but
are fewer, smaller, and attended by less children
Public School Experiences
6 Meriam, Lewis, “The Problem of Indian Administration; 1928, p 573-577, Bergman, Robert, ‘The Human
Cost of Removing Indian Children from Their Families,” in Unger, Steven, The Destruction of American
Indian Families, Association of American Indian Affairs, New York, 1977
7 Coolidge, Dane, ‘Kid Catching” on the Navajo Reservation: 1930, in Unger, Op. Cit, 1977
8 Meriam, Lewis, “The Problem of Indian Administration; 1928
9 Attneave, Carolyn, “The Wasted Strengths of Indian Families,” in Unger, Steven, The Destruction of
American Indian Families, Association of American Indian Affairs, New York, 1977
10 Hollow, Walt, “Health and Mental Health”, in Indian and Alaska Native Mental Health Seminars, Seattle
Indian Health Board, 1982, p.263.
Prejudice from both teachers and non-native students
Direct comparison with students from non-Indian homes
a greater emphasis on academic achievement
more material possessions
better educated parents
more money
Tribal students face a lack of understanding by school authorities of their home
life and culture: may convey the unconscious attitude that native ways are inferior
to dominant culture ways
Tribal children typically fall behind and by 3rd or 4th grade lag considerably –
issues with rebellion and puberty complicated by cultural identity issues
The native dropout rate in Washington State varies from 60 – 80 per cent, many
tribal students leave school be 10th grade11
Many native parents are suspicious, hostile, and mistrusting and may convey this
attitude to students:
Students are caught between divergent expectations and become
discouraged, angry, and self-destructive
Many native adolescents develop problems with alcohol or drugs
The Effects of the Introduction of Alcohol to Indian Communities
Natives were unfamiliar with alcohol, had no idea what to expect, and,
historically, tribal cultures had no norms for drinking alcohol prior to its’
introduction by white traders12
Because of the concern of early tribal leaders, it became illegal to sell alcohol to
Indian people on or off reservations for over 50 years beginning in 1902
Often, natives drank out of rebellion or simply to defy the prohibition
on alcohol
Native people faced enormous social, economic, and personal
problems
Indian people were vulnerable to drinking-related problems
Tribal people experienced anger, frustration, & depression
11 Swinomish Tribal Specific Health Plan, 1985
12 Weber, Richard, ‘Alcoholism in the Indian Community”, in Indian and Alaska Native Mental Health
Seminars, Seattle Indian Health Board, 1982, p. 825-826
Natives developed a particularly negative drinking pattern: drank quickly, gulping
drinks and consuming all available alcohol
Drinking with the express purpose of becoming intoxicated
Drinking associated with anger and rebellion
Drinking for drinking’s sake
Drinking large quantities
Alcohol became incorporated into traditional cultural patterns: special, must be
shared, could not be refused without giving offense:
Alcoholism became common among tribal people sent to the cities
through the relocation program
During World War I, natives who could not obtain alcohol at home
learned to drink heavily
In 1953, the federal ban on the sale of alcohol to natives was lifted, allowing it to
be more easily obtained
Stresses Placing Tribal Communities at Risk
Poverty (30% – 90%), unemployment (13% - 40%), accidental death (3 times the
national rate), alcoholism (30% - 80%), domestic violence, teen pregnancies, child
neglect and suicide (@ times the national rate). At some tribes, a drop-out rate: 10 out of
every 13 high school students13, the lowest educational achievement level of any group,
nationally14.
The Spiral of Failure15
Native children enter public school behind in academic skills, labeled as learning
disabled or delayed, public school system is foreign and frightening, subtle prejudice of
peers and teachers damages emotional well-being, less likely to complete high-school,
often continue a cycle of depression, problem drinking, and unstable family life: results
in high levels of emotional and social disturbance
Interacting Mental Health Problems
Chronic mourning, frustration, denial, hopelessness, violence, suicide,
grief over tragic (needless) deaths, child abuse, and family breakup16
Post-Traumatic Stress Disorder: psychological numbness, stimulus
overload, preoccupation, and hopelessness
13 Swinomish Tribal Specific Health Plan, 1985
14 Office of Minority Health Testimony before Senate Select Committee on Indian Affairs on 7/7/88
15 Vanderhorn, Craig, Director, Division of Clinical and Prevention Services, Indian Health Service,
Testimony before Senate Select Committee on Indian Affairs on 7/7/88
16 Debruyn, Hymbaugh, & Valdez, ‘Helping Communities Address Suicide and Violence’, American
Indian and Alaska Native Mental Health Research 1 (3), March, 1988, p.56.
Acute symptoms masked by related problems: alcoholism,
delinquency, violence, or physical illness
Externalization of psychological/emotional problems: physical,
somatic, or caused externally
Multiple interacting family, financial, physical, legal, and
psychological problems
Diagnosis complications: cross-cultural values or symptom patterns
Alcoholism and complications of family dysfunction
Pervasiveness of depression in native communities
Violence and alcohol abuse17
Triad of Depression, Alcohol Abuse and Destructive “Acting Out”
Alcoholism, depression and a variety of stress-related acting out behaviors often occur
together and seem to lead one to another:
Child Sexual Abuse (Situational Molestation)
Unsafe Sexual Activity
Domestic Violence
Reckless Driving
Impulsive Theft
Truancy
Suicide
Fighting
Rape
Triad of Disturbance
DEPRESSION
Racism Broken Familes
Language Loss CULTURAL Poverty
IDENTITY PROBLEMS
Religious Oppression Relocation &
Dispossession
-----------------------------------------------------------------------
ALCOHOL ABUSE DESTRUCTIVE
“ACTING OUT”
BEHAVIORS
Theoretical Root Causes:
17 Skagit Community Mental Health Center
Violence: child abuse leads to depression, low self-esteem, and substance abuse
later in life become abusers of others
Depression: fatalistic self-defeating attitudes and behaviors, including alcohol
abuse, suicide, school failure, etc.
Alcoholism: Depressant effects of alcohol on the body, negative life events
resulting from alcohol, correlation of alcohol abuse with violence,
accidents, family dysfunction, and death
Lack of (Cultural Identity Confusion) or a Negative Cultural Identity & Current Severe
Life Stresses, Thus, Cultural Insecurity Creates the Psychological Condition Out of
Which the Triad of Alcoholism, Depression, and Destructive “Acting Out” Behaviors are
Manifested
Depression
“Anomic” Depression18:
Multiple losses – personal – family – tribal level
Chronic depression (Dysthymic Disorder)
Feelings of inevitable personal doom
Helplessness & hopelessness
Unresolved grief & anger
Acute reactions: suicide
Physical illness & pain
School & job failures
Emotional numbing19
Low Productivity
Low self-esteem
Anxiety
Fatigue
Alcohol Abuse in Tribal Communities
Alcohol abuse is extremely pervasive and devastating
Indian Health Service calls it the number one problem
Not only individuals, but fabric of tribal communities
Many native adults do not drink at all
18 Jilek, W. Indian Healing: Shamanic Ceremonialism in the Pacific Northwest Today. Blaine, WA.:
Hancock House, 1982.
19 Bates, Edward, Promotion of Indian Health, from Indian and Alaska Native Mental Health Seminars,
Seattle Indian Health Board, 1982, p.114
Clinical experience suggests that a larger proportion of native
alcoholics are able to stop drinking, then are non-native alcoholics
Strong cultural tendency of tribal people to take responsibility for self
and community in their forties20
Strengthening Indian cultural identity may help individuals overcome
problems with drinking
Alcohol is a particular problem with teens and young men
“….some tragic things happened when they were young. Booze is a
fine way of stopping the hurt. The trouble is it catches up and
becomes the pain, the hurt”21
The loss of culturally acceptable roles: especially for men
Considerable social pressure to drink: especially for men
Cultural identity confusion
Parental alcoholism
School problems
Low self-esteem
Family conflict
Strands in the Web of Alcohol Abuse
Lack of Positive Role Models (Especially for Indian Men)
Social Pressure to Drink (Fear of Losing Friends)
Breakdown of Traditional Family Life
Childhood Exposure to Alcohol Abuse
Excuses Made for Drunken Behavior
Hopelessness about Social Problems
Cultural Identity Confusion
Low Self Esteem
Tacit acceptance of drinking to handle stress
Excused as the result of unbearable personal stress
Attributed to financial problems
Attributed to marital conflict
Attributed to lack of a job
Attributed to illness
Attributed to death
Many tribes are recognizing the issue of community acceptance and are creating new,
community-wide healthy expectations: pressure for abstinence, widespread tribal support
for recovery and non-drinking lifestyles
20 Weber, Richard, Alcoholism in the Indian Community, Indian and Alaska Native Mental Health
Seminars, Seattle Indian Health Board, 1982, p. 821
21 Stelzer, U. & Kerr, C. Coast of Many Faces, 1979, p.114.
Destructive “Acting Out” Behaviors
A variety of destructive or self-destructive responses to stress
Child physical or sexual abuse (situational molester)
Sexual misbehavior or “unsafe sex”
Impulsive suicide attempts
Reckless driving
Domestic violence
Truancy
Fighting
Rape
Although impulsive violence is often associated with alcohol abuse, clearly, it is also an
unhealthy way of releasing tension and responding to stress
It is important for tribal communities to challenge the thinking that stress-related self-
destructive and other impulsive acting out is unavoidable or “just the way it is”.
Problems related to the Triad of Major Disturbances
Suicide is of related to a combination of long-term depression, anger, and impulsive
“acting-out” & alcohol is often involved
Unresolved or Delayed Grief
Staggering losses, often in rapid succession, thus a normal period of mourning,
readjustment, and recovery might not have been possible
Often, western methods are important adjuncts to traditional
treatments and spirituality
Must resolve losses through grief and mourning
Traditional methods are available and helpful
Early childhood losses create vulnerability
Contribute to adult depression
The Sense of Personal Doom
Tribal individuals cannot identify with the strengths of tribal culture
Powerful self-image with almost mythic dimensions: destiny of a life
of tragedy, failure, and early death
Unexpressed anger, guilt, exaggerated ideas of self-importance: sense
of personal doom
Serious sign of depression to see one’s self as marked for alcoholism
or victimization
Often talented natives with exceptional abilities, charisma, and
potential
Suicide
The national tribal rate is at least twice the national average
Young tribal men between the ages of 15 and 40 seem to be at particular risk for
suicide
Talking about wanting to join dead relatives, an experience of being
visited by the dead might fore shadow suicide
The increased risk of impulse suicide following rejection or
disappointment
Alcohol is involved in over 90 percent of native suicide
Greater vulnerability of young native men
Must address not only the attempt, but the underlying cultural identity confusion,
alcoholism, & depression
Violence
Violence often clusters in tribal families, but is a community wide problem requiring:
Services for both victims and perpetrators to explore positive
alternatives
Social disapproval of violence and confrontation of abusers
Education for non-violent choices and lifestyles
Protection for victims in crisis
Child Abuse and Neglect
Neglect is often based on three things: poverty, parental alcohol abuse, and lack of
adequate knowledge about parenting in today’s world
Help the children express and work through emotional difficulties
resulting from family conflict, neglect, or out-of-home placement
Evaluate the strength of the parent-child relationship
Advocate for the family with the child welfare workers
Provide support to native parents
Historically, it was rare that tribal people physically punished children, many native
people encountered physical punishment in the BIA boarding school system (typically it
was frequent and severe)
As adults, BIA boarding school attendees imported physical
punishment into the traditional tribal culture
Often, when combined with parental alcohol abuse, physical
punishment becomes physical abuse
Sexual abuse has become a serious problem, closely associated with alcohol abuse, some
expert’s estimate that 90% of native women with psychiatric problems have been
sexually abused22
Alcohol or drug abuse
Low self esteem
School failure
Depression
School Problems
Learning problems, behavioral problems, dropouts, withdrawal, and truancy are common:
often abuse, neglect, and depression is first detected in the school system
Post-Traumatic Stress Disorder
Tribal people who have experienced repeated or chronic violence, tragedy and culture
loss, dispossession, alcoholic or abusive families often experience symptoms similar to
rape victims, battering victims, child sexual abuse victims, and military combatants:
continuing anxiety, emotional numbness, preoccupation, or “flashbacks”.
Somatic Disturbances:
Tribal client often experience physical problem instead of “anxiety” or “depression”.
Cultural belief that spiritual problems often cause physical problems
Cultural beliefs that body, mind, and physical are inseparable
Greater social acceptance
Often, referral to a traditional healer is helpful
HIV / AIDS
There is concern that HIV / AIDS will spread rapidly in tribal communities:
22 Testimony of Phyllis Old Dog Cross before Senate Select Committee on Indian Affairs, 7/7/88. U.S.
Government Printing Office, Washington, 1988, P. 21
The highly contagious and lethal HIV / AIDS virus might devastate
small, relatively self-contained tribal populations
Impulsive behavior while drinking might lead to unplanned and unsafe
sexual activity
The generally poor health of tribal people leads to increased
vulnerability to infection
A high rate of occurrence of other sexually transmitted diseases
A Note Concerning “Personality Disorders”
A personality Disorder is a fixed behavior and personality pattern which is (1)
substantially outside of the social norm for a given society and (2) which causes the
individual to have recurrent problems.
Be cautious in applying a personality disorder diagnosis to native client
A Note Concerning “Psychotic” Conditions
Outright psychotic conditions are relatively rare for tribal populations23
Question is if less common or underdiagnosed
Often borderline psychotic states: natives abuse alcohol or act in other
destructive ways. Drinking is seen as the cause of their problems.
Might receive spiritual treatment and improve
Might die early as a result of “acting out”
Summary: Tribal Mental Health Problems and Cultural Identity
Local cultural factors should be considered in diagnosis and treatment. Local cultural
consultants of native or tribal decent are of great value in this process/effort. Treatment
should attempt to resolve cultural confusion and support the development of a positive
cultural identity.
THE IMPORTANCE OF CULTURE FOR MENTAL HEALTH
The Role of Cultural Identity in Mental Health
All human experiences are culturally determined: culture is the integrated pattern of
human behavior which includes thought, communication, actions, customs, beliefs,
values, and institutions of a racial, ethnic, religious or social group24. All the things that
we take for granted.
23 Testimony of Dr. Scott Nelson, Chief of Mental Health of the Indian Health Service. Before Senate
Select Committee for Indian Affairs, 7/7/88.
24 Terry Cross, “Cultural Competence Continuum,” Focal Point, Fall, 1988
Personal Identity is Deeply Tied to Cultural Identity
Tribal people often have been taught to devalue their culture, therefore, they often
devalue themselves
Native children often in a no win situation; they cannot meet the contradictory
expectations of tribal versus native cultures. Therefore, they often feel doomed to failure
Most natives choose an eclectic mix of tribal and dominant value orientations: it is rare
that an individual transcends the confusion, self doubt and frustration created by a
conflicted social environment
A positive cultural identity is crucial for mental health: we must feel at ease with who we
are and basically like and accept our culture
Assessment and treatment of all native clients must include:
Development of a positive cultural identity should be a treatment goal
whenever ambivalence, conflict or a devaluation of the self or culture
group exists
The cultural aspects of the client-therapist relationship should be
considered and often need to be discussed during treatment
The client likely can not be helped to change until he or she
understands his or her cultural values
Treatment approaches must be congruent with the client’s cultural
values and lifestyle
An evaluation of his/her cultural background and identity
Cultural Deprivation
True cultural deprivation is the condition of having been cut-off from or having become
emotionally alienated from one’s own culture
Out-of-balance: psychologically/emotionally
In limbo, neither knows or accepts self
Incomplete and vulnerable
Confused and depressed
Anxious or amoral
Cultural Congruence In Mental Health Services (Jennifer Clarke, Ph.D.)
Belief systems, lifestyle, perceived problems, and culturally identified service needs
should determine the choice of services to be provided
The structural components of the services: intake procedures, time
availability and duration of sessions, charting procedures, therapeutic
goals, therapy techniques, therapy techniques, and the involvement of
traditional healers in treatment
Consider client belief systems, spiritual practices, extended family
relationships, and child rearing patterns, but mental health services
must be directly derived from the cultural base of the group being
served
The traditional versus dominant culture orientation and exposure to
mainstream society of each client (individual & population) must be
assessed
The greater the service cultural congruence and cultural compatibility,
the greater the effectiveness of the service for a native client
The setting within which the services are delivered
The cultural identity of the service providers
Religious and cultural beliefs
The language spoken
Dimensions of Culturally Congruent Mental Health Services
Culturally influenced symptom patterns
Therapist – client cultural sensitivity
The therapist’s cultural integration
Involvement of ethnic authorities
Religious/spiritual appreciation
Client and therapist social roles
Concepts of health and illness
Extended family involvement
Degree of social involvement
Use of traditional healing
Therapeutic approaches
Timing of the services
Setting of the services
Treatment techniques
Diagnostic services
Therapeutic goals
Center of control
Record keeping
Intake process
Language
Stereotypes and the Experience of Prejudice
Stereotypes, both positive and negative, are over-simplifications that make people into
abstract “objects”, “types, or “things”, rather then human beings. In most cases, when a
group with greater power holds a stereotypical view about a minority group, the
stereotypes tend to justify oppression and discrimination. In fact, all prejudice,
discrimination, and ethnic oppression is based on stereotypes. Thus, it is reasonable to
examine some of the most common stereotypes held about tribal people:
Stereotype: Tribal people live on reservations because….
They can’t make it on the outside
They are undereducated
They have no choice
Fact: There are many alternative reasons why tribal people live on reservations,
including:
To shield their children from the prejudice of outsiders
To maintain their culture and way of life
Fear of prejudice or of being alone
To avoid outside interference
To maintain a family feeling
To be with their own people
It is their land and home
Stereotype: Tribal people would naturally want to leave the reservations….
Fact:
Many natives prefer to live on reservations
Consider it their home
Pride in their tribe
Stereotype:
Natives all get “per capita” checks from the government just for being
Indian.
Fact:
Most do not receive substantial per capita or lease: those that do are as
equally entitled to them as any investor
Some receive dividends from the sale/lease of jointly held resources or
investment in the stock market
Some have individual or tribally administered land leases
Stereotype: Government programs for tribal people are charities
Fact
The Indian Health Service (IHS), Bureau of Indian Affairs (BIA),
educational services and benefits are attempts to fulfill treaty
obligations for services guaranteed to tribal people by treaty
Stereotype: All native people drink excessively and are alcoholics
Fact
Many tribal people do not drink or drink very little, some tribal people
have serious problems with alcohol, but others do not
Stereotype: Indians are lazy and can’t work hard or keep a steady job
Fact
Often, native people do not see the value of continuing to work, once
they have obtained what they need
Tribal people often have different priorities than do mainstream whites
Family and/or spiritual pursuits might be more highly valued
Hard work is usually not valued in and of itself
Accumulation of wealth is less valued
Stereotype: Indians are careless and wasteful of money and property
Fact:
Some tribal people feel that it wrong for one person to have more then
others
Sharing is valued over saving, which is seen as selfish hoarding
Natives often share resources among their extended families
The best insurance is the goodwill of others
Stereotype: Tribal families are usually separated and have little cohesion
Fact
Families are often large and very fluid in structure: people move freely
between homes, while maintaining adequate internal cohesiveness
Family is of critical value to native people
TRIBAL/NATIVE WORLDVIEW AND HEALING CONCEPTS
Spiritual World View
In tribal settings, spirituality and religion is pervasive, it effects world view, family
relationships, health, wellness, and illness, ways of healing, and ways of dealing with
grief. It is broad and encompasses religion, psychic, visionary, telepathic and
synchronistic experience.
Spirituality is understood as a fundamental reality of all life and people – there is
a profound interconnectedness between all things – inseparably connected and
continuously interacting
Natives are less likely to perceive the world as falling into discrete categories (i.e.,
physical, mental, social)
World is seen by tribal people as less mechanistic, matter-of-fact, or ruled by
scientific laws
Tribal people commonly believe that taking spiritual maters lightly
leads to harm. It is thought inappropriate to play with spiritual powers
without proper commitment or guidance. Proper spiritual training
carries responsibility and builds character.
There are often prohibitions observed in some spiritual matters and
practices, because of the quality of danger associated with the spiritual
practice or belief
Many natives believe that not only are some spiritual phenomena not
understandable or explainable, but that is in appropriate to attempt to
do so
Often, tribal spiritual leaders do not desire or can not reduce native
culture to simplistically explained spiritual phenomena
Many non-natives are seen as disrespectful, because they take some
spiritual things too lightly
Often, the eagerness of non-tribal people is thought of as intrusive or
rude
Most native people approach spiritual events with great care and
respect
Disharmony is a dangerous and vulnerable state of being
Complex, powerful, ambiguous, and dangerous
Intensely personal sort of experience
How one conducts oneself
What happens to someone
Beliefs
Spiritual Privacy
Many tribal spiritual beliefs and practices are extremely private in nature
Privacy preserves ones special relationship to a spiritual being
Privacy avoids ridicule or persecution from non-natives
Privacy avoids potential misuse of spiritual knowledge
Privacy avoids the loss of spiritual power
Privacy demonstrates respect
Spiritual Healing Tradition
Ceremonial practices and methods: traditional mechanisms for healing of physical and
spiritual disturbances
Helping the family of the deceased to safely and successfully complete
a period of mourning
Keeping in proper balance with the seasons and with forces of nature
Acknowledging a new spiritual power or song
Teaching proper conduct to young people
Showing respect for spiritual forces
Honoring the dead
Healing the sick
Most tribal groups acknowledged certain persons as having special knowledge, healing or
spiritual power or gifts
Many natives believe that the spirit must be healed in order to heal the mind
Family participation is often a prerequisite to a healing ceremony
Prayer, music, and song
Prayer is a tribal person’s way of putting themselves in tune with the universe: music,
drumming, and songs have a special significance to many tribal peoples as forms of
prayer
TRADITIONAL CONCEPTS OF HEALTH, ILLNESS, AND MENTAL ILLNESS
The idea of being in balance or right with the world is central: the actions of family
members are seen as having either positive or negative repercussions for tribal
individuals. Illness can result from bad feelings, ill will, social conflict, or unresolved
tensions
Severe emotional/psychological disturbance may be attributed to soul loss, spirit
possession, loss of the breath of life, or “evil” work by an enemy
Compelling intuition, visions, and powerful dreams are common: in many cases
are thought of as gifts, rather than pathology
Personal problems are often seen as externally caused, rather then as the result of
internal conflicts
Mental illness is often seen as shameful or unnatural
Traditional Ways of Helping and Healing
Seeking to restore the balance of spiritual forces both around or within
the individual
Certain individuals or families recognized as helpers
Removing dangerous spiritual influences
Giving immediate emotional support
Bringing family groups together
Dietary and/or herbal remedies
Consultation with elders
Prayer and song
Sharing meals
Mental health workers can consult with traditional elders/medicine people
These can be combined with modern western methods/techniques
Traditional Expectations of Helpers
Should lead exemplary lives and have some special qualities: caring, understanding, or
spiritual powers
Available when needed, goes to client’s homes, stay as long as needed
The Extended Family
Often-tribal families are large and inclusive: fluid and flexible
Childhood
Loved and indulged, greater freedom than non-native, individuals, but with reflections on
their families
Teaching
Special teachings, advice, or knowledge kept within the family
Individual Gifts
Born with or obtained through spirituality: carefully cultivated
Role of Elders
Their past achievements and contribution to the welfare of others
Whether or not they are respected by their own family
The overall social standing of their family members
Their current helpfulness to younger people
Their spiritual and traditional knowledge
Their ancestry
Their age
Grief and Loss
Burning or giveaway of private owned materials of the deceased
Elders speak about tribal issues and provide support for grieving
Large funerals in a tribal building: work often ceases
Socially constructed roles for helping during death
Death to funereal: enormous social support
Traditional cleansing following a death
Large meal followed by a give-away
Mixed Christian/tribal ceremonies
Support of family and friends
Prayer services and vigils
Respect for Ancestors
Spirits of people, whose gravesites have been disturbed might cause
problems, sickness, or misfortunes
Spirits might come out at night and cause harm to people, especially
near burial sites
Spirits can haunt a house and might cause harm to people living there
Spirit might attempt to take family members to ease their grief
Spirits might make family sick if possessions are not burned
Spirit might linger and cause trouble
Social Etiquette: The Unspoken Rules of Tribal Relationships
Togetherness, hospitality, and sharing
Inter-Family Relationships
Social Involvement
Social Status
Informality
Respect
Gift-giving
To please someone by giving them something that they have admired
To blot out a shame, dishonor, mistake, or insult
To pressure someone to do something
To even out a status imbalance
To thank others for their help
To demonstrate superiority
To show respect
To honor, thank, or even insult or shame others
Decision-making
Typically done in a consensus fashion, by entire families or groups, may take a long time,
might be based on the advice of an elder, might not be made at all: allowing events to
unfold
Non-self assertion and non-interference
Consensus and group decisions more valued then individual methods
Social Pressure and Social Controls: Gossip, Ignoring, and Shaming
Values
Share your money, your time, and your possessions
Respect religious and spiritual leaders and beliefs
Participate in community gatherings and events
Value native traditions, do not be too “white”
Don’t be too assertive, know your place
Contribute to the community good
Be loyal to your family members
Do not stand out as different
Recognize your relations
Respect your elders
Attitudes towards time
Social responsibilities take precedence over appointments
“Indian time” refers to doing things at a natural pace
Being on time is less important than being present
Verbal versus non-verbal communication
Handshakes are often less gentle then non-native handshakes: sometimes leads to
negative impressions and misunderstandings between natives and non-tribal people
Expression of overt emotionality is often less dramatic, especially negative affect might
be expressed more subtly
Humor, joking, and teasing is very common and tends to be dry, subtle, and deadpan.
Understatement is common.
Direct eye contact is often avoided: it is considered disrespectful, rude, intrusive, or
intimidating
Native may prefer longer silences than are comfortable for non-Indians
Primary Resource for this Lecture
A Gathering of Wisdoms – Tribal Mental Health: A Cultural Perspective. (1991).
Swinomish Tribal Mental Health Project. Veda Vangard: Mount Vernon,
Wa.
I would like to acknowledge the powerful and important book mentioned
here as the primary resource for this lecture. Its value and the contribution of the
authors to current and future mental health programs and practitioners who serve
tribal clients can not be overstated. I am grateful to them for their fine efforts and
extend full credit to them for the basic ideas underlying this lecture outline.
Joseph B. Stone, Ph.D., CAC Level III, ICADC,
Program Manager and Clinical Supervisor
Confederated Tribes of Grand Ronde
Behavioral Health Program and
Kinuk Sisakta Consultation,
Training, and Research
Services
