Is there such a thing as indigenous mental health? Implications for research, education, practice and policy-making in psychology

In consideration of the extraordinary high prevalence of mental health and substance abuse problems among many indigenous peoples, as well as the associated relative ineffectiveness of standard mental health practices, a call is made for “evidenced-based, culturally relevant health practices that emerge from a constructionist framework rooted in Indigenous psychologies”. Such practices would address the major themes of identity/self, historical trauma, cultural-specific mental health and well-being practices, cultural mistrust, empowerment, and political action.

By Carlota Ocampo, PhD

There is little question that mental and physical health are top priorities for Indigenous and First Nations' peoples' well-being globally. Ask First peoples themselves: On a National Aboriginal Health Association survey undertaken in Canada (Silversides, 2010), Inuit, Metis and other First Nations peoples identified mental health and substance abuse among their top five health issues (with cancer, diabetes and diet and nutrition). Suicide is prevalent in First peoples' communities. Estimates vary, but the U.S. Indian Health Service consistently reports that suicide rates are much higher (i.e., up to 70% higher) among American Indians and Alaska Natives than the general population, particularly for young men and boys (see IHS suicide prevention website). Grief and trauma responses are also prevalent among First peoples (Bryant-Davis & Ocampo, 2006). The observation that mental health issues are rampant in Indigenous communities is nothing new.

And yet: "Research into Indigenous health has been largely focused on non-Indigenous, rather than Indigenous, notions of health" (King, Smith & Gracey, 2009), while at the same time, "counseling of Indigenous patients from mainstream perspectives may perpetuate oppression" (Duran & Duran, 1995). In other words, our mental health frameworks, when applied among First peoples, may result in further trauma and perpetuate, rather than address, their problems. What to do?

I call on psychologists to take a leading role in promoting evidence-based, culturally relevant mental health practices that emerge from a constructionist framework rooted in Indigenous psychologies. Black psychologists have identified constructionism as a culturally relevant paradigm that goes beyond redefinition of Eurocentic models for use among people of color (or oppressed peoples) but that constructs unique psychological models and practices from the homogenous individual cultural and historical experiences of oppressed peoples (Jones, 1998). To this end, I would like to outline several key elements researchers, educators, practitioners and policy-makers must consider in enhancing the psychological well-being of First Nations peoples. Keep in mind that globally, there is wide diversity among First Nations' peoples and their cultures. Each culture and individual within a culture must be approached as unique. At the same time, themes emerge from shared experiences of genocide, bondage, colonization and alienation that have affected and continue to affect First Nations peoples worldwide.

  • Identity/Self: Many First Nations peoples embrace a shared group identity whose substance is formed not just by one's relationship to the community but also to the land and one's ancestors, which may include plants, animals and other elements of nature. For example, traditional Native Hawai'ians consider the taro, a root staple that nurtures them, a physical ancestor now under their guardianship. Thus, reduction or dispossession of land/loss of stewardship of one's traditional plants and animals is experienced as an alienation or unmooring from the self, and in some communities is directly correlated with suicide (i.e., among the Guarani of Argentina - see Robinson, 2008). Psychologists must identify and investigate evidence-based practices that reverse this erosion of the self among First Nations' peoples. (Please note that this is a tricky political proposition as Indigenous land dispossession is ongoing in many parts of the world, and restoration of the self theoretically would accompany Indigenous sovereignty.)

  • Historical Trauma: Many First peoples suffer not only from the proximal traumas of emotional, physical and sexual abuse and/or family violence but also from intergenerational trauma inherited via shared experiences of genocide, colonization, and alienation. Psychology must designate historical, inter-generational and racist incident-based trauma symptoms as legitimate trauma sequelae and do a better job of leadership in the areas of research and policy-making around acknowledging and healing historical trauma, of Indigenous and other oppressed peoples.

  • Cultural-specific Mental Health and Well-being Practices: First Peoples have traditional psychological systems and healing practices, often based in spirituality, ceremony and ritual (e.g., "limpias" or spiritual cleansings among Mayans in Guatemala), but also relevant are language, harmony with the community and the environment, and cultural practices. While much anecdotal evidence exists that such models are beneficial for First peoples, we need more reliable data regarding evidence-based practices that really work, perhaps in combination with psychological and psychiatric approaches (such as CBT and medication). We especially need evidence regarding effective approaches for acculturated (i.e., dispossessed and alienated) urban Indians and Indigenous peoples.

  • Cultural Mistrust: Psychologists must find a way to measure and address the cultural mistrust that many First peoples feel toward government (i.e., colonized) medical services. For example, at a recent conference Inuit leaders reported they would not allow travel "south" (off the reservation) for medical care, due to past experiences where children disappeared and were never heard from again (as in the 1950's tuberculosis epidemic in Canada) (Silversides, 2010). Cultural mistrust is a particularly tricky proposition when psychology is a product of the culture of the colonizers and even Indian or Native psychologists must receive training within the colonial education system.

  • Empowerment: Recruit more Indians, Alaska and Hawai'i Natives, and global Indigenous peoples into the field of psychology as researchers, educators, practitioners and policy-makers. Empower them with the necessary tools to elucidate and develop evidence- based culturally relevant mental health constructs and paradigms that are community specific. This requires financial investment, i.e., more money.

  • Political Action: Psychology must stand up for the dispossessed but also support political movements that preserve the existing way of life of traditional Indigenous communities. The age of colonization is not yet over, and we must use our education and our power to resist it. This would be a primary prevention approach to Indigenous mental health issues — address them before they are created.

Is there such a thing as Indigenous mental health? I hold that we do not yet fully know what such a construct will look like, other than restoration of the Indigenous to an uncolonized state. Yet even this conceptualization has its limitations - it must not be viewed through the lens of romantic naivete which many in our mainstream culture use to gaze in simplistic nostalgia on the "primitive". Indigenous people are just as much a part of the complex modern world as any of us, and Indigenous psychologies are equally complex and important. They may not look like our psychologies; they may be different, they may be unique, but they must be nurtured, respected and allowed to emerge. A key concept psychology must focus on in Indigenous mental health: empowerment. As Nathan Obed, the director of social and cultural development for Nunavut Tunngavik, Inc, an Inuit group, told a recent body of conference-goers: "The definition of normal must be changed" (Silversides, 2010).

References

Bryant-Davis, T., and Ocampo, C. (2006). A therapeutic approach to the treatment of racist-incident-based trauma. Journal of Emotional Abuse, 6, 1 (22 pgs).

Duran, E. & Duran, B. (1995). Native American post-colonial psychology. Albany: State University of New York Press.

Jones, R. (1998). African American mental health. Hampton, VA: Cobb & Henry.

King, M., Smith, A. and Gracey, M. (2009). Indigenous health part 2: Underlying causes of the health gap. The Lancet, 374, 76 (10 pgs).

Robinson, K. (2008). Guarani suicide. The Argentimes.com: http://www.theargentimes.com/feature/guarani-suicide-/

Turner, S., and Pope, M. (2009). North America's Native Peoples: A social justice and trauma counseling approach. Journal of Multicultural Development, 37, 194 (12 pgs).

Silversides, A. (2010). Inuit health system must move past suicide prevention to "unlock a better reality", conference told. Canadian Medical Association Journal, 182, p. E46.

Smith, B., Sabin, M., Berlin, E., and Nacherud, L. (2009). Ethnomedical syndromes and treatment-seeking behavior among Mayan refugees in Chiapas, Mexico. Culture, Medicine & Psychiatry, 33, 366 (16 pgs).

U.S. Department of Health and Human Services Indian Health Service. (n.d.). IHS American Indian and Alaska Native suicide prevention website. URL: http://www.ihs.gov/nonmedicalprograms/nspn/

Carlota Ocampo, PhDCarlota Ocampo, PhD is associate dean of the College of Arts & Sciences at Trinity University in Washington, DC where she also holds the position of tenured associate professor of Psychology and Human Relations. She received her PhD in Neuropsychology from Howard University in 1997. Her teaching and research interests encompass cultural diversity, psychology of oppression, and health psychology.