First Nations Cultural Perspective on Mental Disorders, Research Paper Example

The First Nation peoples consist of those Aboriginal peoples who reside in Canada, other than the Inuit and the Métis people (those of mixed First Nation and European heritage). Statistics Canada records the Aboriginal population as about 1.17 million people, with about 700,000 claiming only First Nation heritage and another 470,000 claiming Inuit, Métis, or mixed heritage, out of a total population of 31.24 million (Statistics Canada, 2011). Most of the First Nation peoples live in Ontario or British Columbia, though they are spread over most Canadian provinces.

As the First Nations peoples encountered the Europeans moving into North America, the native culture came under attack, with much of it destroyed by the Western intruder; it is this destruction of culture that has contributed strongly to health issues in the First Nations peoples (Cook, 2005). In 1996, the Royal Commission on Aboriginal Peoples promoted four key aspects of Aboriginal health reform, including approving traditional medicines and healing modalities to improve overall patient outcomes (Cook, 2005). Furthermore, the Society of Obstetricians and Gynecologists of Canada’s Aboriginal Health Issues Committed also noted the importance of respecting traditional medicines and Aboriginal healers and to accept a more holistic definition of health as the Aboriginal peoples themselves define it (Cook, 2005).

When it comes to mental health issues, it is thus important to come to terms with how the First Nations peoples perceive mental illness. In addition, for Christian therapists who deal with First Nations clients, these perceptions must impact care decisions. This paper briefly reviews the attitudes of First Nations peoples toward mental illness and then discusses the implications of these attitudes for Christian therapists working with these clients.

Perspectives of First Nations Peoples on Mental Health and Illness

Studies have noted the importance of beliefs and values about health among First Nation peoples as they go for care at Western healthcare centers. In particular, authors have noted that using more traditional healing practices results in improved patient outcomes (Buchwald, Beals & Manson, 2000; Marbella, et al., 1998). Researchers have speculated that aspects of Aboriginal health, particularly those that concern mental health issues such as trauma and alcohol abuse, are poorly addressed by Western medicine (Cook, 2005).

Native American healing traditions have a different perception of healing than exists in Western medicine. Rybak and Decker-Fitts (2009) noted that the Native American concept of healing was more in terms of establishing a wholeness of the individual and bringing that person back into balance with nature rather than in seeking a cure. Furthermore, the concept of healing in this tradition is holistic, and seeks a balance of mental, spiritual, emotional, and physical; inclusion of all three considerations, including the non-material, is considered an essential aspect of healing (Rybak & Decker-Fitts, 2009). Thus, the ultimate focus of healing is on the energies between people, between the individual and the earth, and restoring a connection between the individual and all that exists in the universe, including animals, plants, earth, water, and everything else (Rybak & Dekcer-Fitts, 2009).

First Nations people coping with Western society are often stigmatized as being vulnerable to alcoholism, yet there is no scientific evidence to support a biological or racial tendency to alcoholism (Coyhis & Simonelli, 2008). A program called Wellbriety addresses Native Americans with addiction issues by addressing not only the issues of physical addiction but also by attempting to restore that balance with the universe considered vital to the First Nations concept of wellness ( Coyhis & Simonelli, 2008).

It is also of value to note how First Nation individuals who have experienced a persistent mental illness themselves perceive the concept of wellness and unwellness. Yurkovitch and Lattergrass (2008) surveyed 44 Native Americans suffering from such chronic mental health issues, and found that their perceptions of health matched that of their native culture, i.e., being in balance, having a sense of harmony with nature, being in control, and having control over their mental, spiritual, emotional, and physical lives. The relevant symbol for such wellness was the medicine wheel, or Circle of Wellness, shown in Figure 1. The meaning of this is that all is interconnected, not just with other people, but also with everything on the planet and in the universe (Yurkovitch & Lattergrass, 2008).

Figure 1. Native American medicine wheel, showing balance between spiritual, emotional, physical, and mental worlds. (from http://www.spiritualnetwork.net/)

In the Circle of wellness, each quadrant of the refers to one of physical, mental, social, and emotional well-being, and the central point, which holds the circle together, is the realm of spirit and spirituality. The balance of all aspects, and, in particular, the importance and centrality of spirituality exemplified the concept of health and wellness (Yurkovich & Lattergrass, 2008). The wheel symbolizes that the knowledge within the circle is constant and that everything in life is part of that circle, which represents the totality of all aspects of existence, the interconnectedness of the elements of the circle, and also symbolizes life itself (Vukic et al., 2011). While the circle does represent a holistic view of the universe, illness (mental or physical) is not merely a simple imbalance in the circle, and mental illness cannot be reduced to a simple physical disorder, such as incorrect serotonin levels in the brain (Vukic et al., 2011). Thus, First Nation perspectives on mental wellness go beyond psychotropic pharmacology to fix a mental condition. Such an approach implies a Western mind-body dualism that implies a biological cause for such illnesses (Vukic et al., 2011). Instead the First Nations approach to wellness is a unified perspective in which all elements of a person’s life, including their connections to the community and to nature, are part of the overall wholeness of their condition (Vukic et al., 2011).

The problems reported by First Nations peoples, issues of chemical use and abuse, betrayal at the personal or community level, violence and abuse of all types, loss, and stigmatization appear to be present in some degree in all tribal affiliations; what is unique are the specific symptoms that people experienced as a result of these toxic environments (Yurkovich & Lattergrass, 2008). Similarly, in a study of the mental health of First Nations women in Ontario, the First Nations women reported twice the rate of depression, but only two-thirds the rate of alcohol use as Canadian women in general (MacMillan et al., 2008). The First Nations women had a higher number of alcohol abstainers, but also a higher number of binge drinkers (five or more drinks on one occasion) than the general population (MacMillan et al., 2008). In addition, the First Nations women had a substantially higher rating of their distress in their lives than in the general population (MacMillan et al., 2008).

One key issue in First Nations health is how mental illness is perceived in their culture. It should be noted, however, that First Nations peoples are not a homogeneous population. In particular, there are more than 560 federally recognized tribes in the United States and more than 630 First Nations governments recognized in Canada (Grandbois, 2005). Evidence shows that the degree of stigmatization attached to mental illnesses within the First Nations correlates with the degree to which the community has been separated from their traditional belief systems (Grandbois, 2005). Additional stigma also appears to derive from the process of forcing First Nations peoples into the Western health belief system (Grandbois, 2005).

It is also not true that all First Nations peoples attach the same degree of stigma to mental illnesses; some tribes attach little stigma to mental disorders in large part because these tribes associate mental and physical systems as being much the same (Grandbois, 2005). In contrast, other tribes stigmatize mental illness to a very high degree and accept the Western health system’s assessments and treatments of some mental conditions but not others (Grandbois, 2005).

Mental illness in First Nations peoples can be considered as deriving from any of several causes, including supernatural possession, imbalance and disharmony with the natural and spiritual world, and the outward evidence of a special gift (Grandbois, 2005). The entire concept of mental illness is actually new to the Native American tradition, dating back only to the European conquest; until that time, mental health symptoms were considered to have a physical cause (Grandbois, 2005). Behavior that in Western society would be considered evidence of mental illness, in the First Nations was considered simple bad behavior (Grandbois, 2005). When Europeans imposed their concepts of mental illness on the Native American societies, the attempts to “cure” mental illness frequently resulted in spiritual, physical, sexual, and emotional brutality in an attempt to remove the individuals from their native cultures (Grandbois, 2005). The result is that many First Nations people have a strong mistrust of White people, and European medical treatments (Grandbois, 2005). This mistrust is so strong that it could be classified by Western-fixated clinicians as paranoid psychosis or paranoid personality disorder, simply because the clinician has no real understanding of, or perhaps no sympathy with, the historical abuse the First Nation peoples have suffered under European hands (Grandbois, 2005).

Culturally insensitive clinicians present First Nations clients with treatment options and perspectives on their condition that are foreign to their patients’ worldviews and cultural traditions which generates a clash in values between clinician and patient (Hodge, Limb & Cross, 2009). The result is that the patient is encouraged to leave their traditional culture behind and adopt a more European-centered worldview, and traditional Western therapy is a process of deculturing Native Americans and re-culturing them into that European worldview (Hodge et al.,2009).

Implications for the Therapist

The differences in worldview between the First Nations perspective on mental wellness and the Western perspective generate a variety of implications for the appropriate relationship between Christian therapists and First Nations clients. First Nations peoples have legitimate and serious concerns about Western mental health issues. Key among these are the disconnection many First Nations people feel from their traditional cultures, which they believe promotes alcoholism, violence, drug use, and high rates of dropouts from school; it may also contribute to high rates of teenage suicide (U.C. Davis CRHD, 2009). Other factors that concern First Nations people are lack of cultural awareness and culture sensitivity within mental health professionals for the traditional cultural values. The historical traumas experienced by these people are still resonating in the psyches of the First Nations people, generating ongoing problems (U.C. Davis CRHD, 2009). Nuttgens and Campbell (2010) noted that achieving such cultural sensitivity is the responsibility of the clinician, although it is impossible on a pragmatic basis to tailor therapies to each of the hundreds of tribal traditions. On the other hand, a study that did precisely that type of cultural tailoring when dealing with post-traumatic stress disorder (PTSD) in Native Americans recovering from trauma and who were hospitalized in two trauma centers in the Western U.S. showed some success in tailoring PTSD and other symptoms while in a Western hospital setting (Tsosie et al., 2011).

In a study that compared semi-structured interviews with a psychiatrist, a psychologist and a tribal elder, significant differences appeared in how to approach these issues. While the elder noted that growing cultural awareness was not a case of forcing the Aboriginal sacred ways on Westerners as a way of educating them. Instead, the elder promoted partnerships between Western and Native American healers as a more appropriate solution path (Crowe-Salazar, 2007). The psychiatrist interviewed noted the need to have a knowledgeable person available in the office to assist with determining how best to meld traditional and Western healing practices (Crowe-Salazar, 2007). The psychologist noted that the current demand for evidence-based practices make it difficult to escape Western treatment modalities, and when they do not work for a particular patient, the onus of failure is often implicitly placed on the patient and not on the inappropriateness of the treatment for that patient (Crowe-Salazar, 2007). In contrast to these differences, the study noted key commonalities of importance, including that all three interviewees had a strong desire to help others, that they emphasized the importance of being humble and not assuming that the therapist necessarily knew the answer, and that the process was often one of gifting others (Crowe-Salazar, 2007).

Vukic et al. (2011) proposed a series of principles for such therapeutic relationships which:

• Considers the overall community rather than focusing solely on individuals;
• Focuses on protecting and enhancing well-being and quality of life;
• Considers all aspects of individuals, including physical, social, mental, emotional and spiritual environments;
• Includes complementary medicines and treatments deriving from tribal traditions;
• Extends beyond simple health care to consider the wider world;
• Empowers the community to participate and engage in improving overall wellness.

Figure 2. A holistic model of healthcare combining Western medicine and First Nation traditional care (from Nebelkopf & Wright, 2011).

One approach to providing this type of holistic care was described by Nebelkopf & Wright (2011). This holistic approach provides an integration between Western medicine and traditional Native American approaches and understanding of wellness. As noted in Figure 2, treatment, prevention, and recovery all intersect at the level of the total community (Nebelkopf & Wright, 2011).

Hubbert (2008) described a particularly appropriate approach that merged a Roman Catholic faith-based Western healthcare system with that of traditional Native American healers in the American Southwest. The goal of the partnership was not to become like the traditional healers, but instead to share the wisdom of the traditional tribal healing with both clients and other professionals as a way to enhance the quality of life for everyone (Hubbert, 2008). This approach took a five-step process (Hubbert, 2008):

• Acknowledge the traditional beliefs as important to integrate in the healing process;
• Determine how to incorporate the traditional processes in the nursing assessments;
• Find physical space to accommodate spiritual practices within the health center;
• Welcome traditional healers and acknowledge their value;
• Blend the cultural and spiritual practices of the Native American with the healthcare practices of Western medicine.

The program focused specifically on discovering and celebrating the similarities between a Catholic, faith-based healthcare system and the cultural and healing traditions of the Native American patients (Hubbert, 2008). The key to success in this project was not only increasing the cultural sensitivity and awareness of the healthcare professionals, but also in bringing a traditional healer into the healthcare system as a consulting professional, even to the point of hiring the healer and providing office space and open access to the hospital and all clients, employee, or family member who requested his services (Hubbert, 2008).

An interesting aspect of such respect for traditional healing is that some clinicians are beginning to make use of First Nations healing techniques such as Ayeli, a centering technique, in group therapy work to encourage patients to reflect on belonging, mastery, independence, and generosity, all hallmarks of Native American cultures (Garrett et al., 2008).

Conclusions

The First Nations have a very different perspective on wellness and health than exists in the Western healthcare system. The focus of such Native American beliefs about mental illness is on a holistic approach to the individual as a whole being, but also as an integral part of the community and of the universe as a whole. Mental illness, as defined by Western healthcare, results in stigma for the sufferer from within their tribes, which only adds to their distress. The approach of culturally insensitive clinicians, although not intentionally harmful, can cause more distress by forcing a process of disenculturing the client from their traditional worldview, then reculturating them toward the Western worldview.

In considering how best to improve this situation with Christian, Western-based therapists, the research suggests that taking a more holistic approach, respecting and embracing traditional healers, and incorporated appropriate healing traditions into the treatment plan can be successful. Of particular note in that regard were the testimonies of two such programs, one that has worked for more than ten years (Nebelkopf & Wright, 2011), and another, based in a Catholic, faith-based healthcare system that has embraced and respected local Native American healers (Hubbart, 2008). While it may be challenging to meld a Christian faith-based Western medical approach to mental illness with that of a First Nations worldview, such projects demonstrate that it is quite possible to do so, if the participants want to accomplish that.

References

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