This week marked Indigenous People’s Day, a day that is meant to celebrate the approximately 7 million American Indian, Alaska Native, and Native Hawaiian survivors of ancestors who originally inhabited these lands before they were colonized by European settlers. The colonization process involved genocide, theft of land, forced relocation, repeated broken promises, and the intentional dismantling of Indigenous cultures. One particularly striking example of this was a school system founded to replace American Indian cultural traditions with European norms, which operated under the slogan “Kill the Indian, Save the Man” (Pratt, 1973). These acts, which have sometimes been called the “original sin” of the United States, have implications for mental health care today.
Professor Joseph P. Gone of Harvard Medical School wrote an American Psychologist article titled, “The (Post)Colonial Predicament in Community Mental Health Services for American Indians: Explorations in Alter-Native Psy-Ence” (Gone, 2021). In it, he points out that Indigenous people experience higher rates of post-traumatic stress, substance use disorders, depression, and suicide than their non-Indigenous, white counterparts. At the same time, mental health services for these populations are underfunded and understaffed. These facts alone constitute a public health problem. Still, Professor Gone argues that our mental health care system may be ill-equipped to address them because of our failure to understand how the original sin reverberates in these problems.
Most mental health professionals in the United States would be tempted to address a lack of service providers by seeking more funding to hire more staff and combat high rates of mental disorders with evidence-based psychotherapies. Yet, Professor Gone’s interviews with tribal community members revealed that such an approach might be doomed to failure.
More mental health providers offering evidence-based therapies may not be welcomed by American Indian clients because engagement with the professional mental health care system typically requires replacing Indigenous cultural traditions with practices recommended by the professional. While it is not unusual for psychotherapists to ask their clients to substitute their behaviors for behaviors recommended by the therapist, for American Indians, this request comes in the context of a history of European culture forcefully suppressing Indigenous culture.
This history makes the very process of engaging in “mainstream” mental health care a much more complex endeavor for many Indigenous people. It is no wonder then that some Indigenous clients might describe modern psychotherapy as “brainwashing” Indigenous folks to be (and think) more like “white” folks. It is also not surprising that one study found that close to 50% of American Indians on one reservation preferred to consult traditional healers over mental health professionals (Beals et al., 2005).
Furthermore, there appears to be a mismatch between how mental health problems and treatment are conceptualized in American Indian versus mainstream United States culture. Mental health problems in the United States are largely framed through a biomedical or a psychobiological lens in which the source of the problem is within the suffering client, e.g., in terms of his/her genetic vulnerabilities, psychodynamic, and/or cognitive distortions. American Indian culture demands that their mental health problems be viewed through the lens of the historical trauma and ongoing oppression faced by these communities.
The analysis offered in the Gone (2021) article proposes that the American Indian genocide and persistent obliteration of traditional culture created deep emptiness sometimes referred to as a “soul wound” that is the fundamental cause of the depression, substance abuse, and suicide now observed in this community. If so, then the remedy will probably not be interventions that ignore Native traditions and impose practices that seem to echo European cultural values.
Instead, Gone argues that an incorporation of and deep engagement with Indigenous cultural values and traditions may often be an essential part of healing for American Indian sufferers. It therefore behooves all of us, especially professionals in the mental health field, to take every opportunity to learn more about Indigenous cultures. We offer the following resources to help you get started: