I lived in two parallel worlds," said Lewis Mehl-Madrona M.D., Ph.D.,
a psychiatrist and an associate professor of family medicine and psychiatry at
the University of Saskatchewan.
Those worlds were not just of place and time, but of history and culture,
as Mehl-Madrona and other American-Indian psychiatrists know.
Crossing back and forth from one culture to another is hardly uncommon for
anyone, like immigrants and members of minority groups, who, by choice or
necessity, have spent parts of their lives as participants in more than one
For Mehl-Madrona, one world (his right brain) was indigenous and
ceremonial, a tie to his American-Indian ethnicity, said Mehl-Madrona, who is
of Cherokee and Lakota ancestry, in an interview. It remained in his mind even
as his rational left brain kept him on the job in emergency medicine for 27
years. In the ER, things were cut and dried, he said; there was no question of
what to do next.
That conflict was reflected in his ambivalence about a choice of specialty.
He considered psychiatry after graduating from Stanford Medical School in
1975, but his relationship to the field had an approach-avoidance quality. His
psychiatry residency stretched over 20 years at three institutions,
interspersed with a family medicine residency, the years in the ER, and a
Ph.D. in psychology in 1980.
Over time, though, he managed to integrate the two halves of his mind and
his career. His experience in two cultures has helped him no matter who his
patient may be.
"Too many times, medical people—including
psychiatrists—say: 'We know it all. Listen to us. It'll be fine,'"
he said. "That leads to resentment. The patient feels unimportant and
stubborn, and [is] ultimately noncompliant."
Indigenous communities ask one thing of mental health workers, he said:"
Listen. Allow us to be separate but different."
Newcomers should not assume they know everything. Find an older mentor
within the community to help learn about the community, its healing practices,
and its values, urged
Mary Hasbah Roessel, M.D., embodies overlapping cultures. She is a staff
psychiatrist at the Santa Fe Indian Health Services Hospital and Clinic in
Santa Fe, N.M., and the granddaughter of a traditional Navajo healer.
Credit: Aaron Levin
"If you watch how elders work, you'll see it's entirely through
stories," he said. "People like that approach."
After all, many forms of psychotherapy, from psychoanalysis to
cognitive-behavioral therapy, depend on narratives, so they are not so far
from native traditions, he said.
Nor are native traditions far removed from a biopsychosocial model. As a
former ER doctor, he was puzzled by the old analytic model of avoidance of the
"It was not easy for me," he said. "Now, it's easy to use
drugs, but if you don't intervene in other ways, the patient will be back in
two months. Social intervention is critical. If not, society overpowers the
Mary Roessel, M.D., has also spent a life and a career moving back and
forth across similar boundaries. Her interest in psychiatry was planted early.
She grew up on Navajo reservations in Arizona, the daughter of two teachers.
Her mother was Navajo, her father was not. Her parents met Karl Menninger, M.D.,
at a conference, and he later visited the family on the reservation. Menninger
wrote about the connection between Navajo healing and psychiatry and even
declared that the Navajos were the first psychiatrists, said Roessel. He
encouraged her interests in science, as well.
Roessel thought about veterinary school, but later chose medical school at
the University of Minnesota. She first considered family medicine as a
possible specialty, drawn to it as a way of being of service.
"But after a psychiatry rotation in my third year, I felt that
psychiatry was a more holistic way of dealing with people, like the Navajo
culture," she said.
Today she is based at the Santa Fe, N.M., Indian Hospital but spends
several days a month at the Santa Clara and Santa Domingo pueblos. There she
attends clinics, makes some home visits, and trains tribal staff members.
Adapting contemporary psychiatry to another culture is more complex than
simply pushing a switch, she said.
"It means thinking about patients' culture of origin, their language,
and how they identify themselves," she said. "How do they look at
their illness from both medical and cultural perspectives?"
Knowing the long view of history is critical, too. The physical destruction
and dislocation of American Indians in the 19th century may be known to most
non-Indians. However, a variety of policies of the 20th century, like the
boarding school system that removed children from their homes, left many
Indians adrift, stripped of their culture and caught in a pattern of ongoing
intergenerational trauma, she said.
With that in the background of every conversation, patients frequently find
it a relief to talk to someone like Roessel, who shares their perspective on
the world. In fact, 75 percent will see a traditional healer first before
coming to a psychiatrist, she said.
Roessel also takes a long-term view of improving access to medical and
psychiatric care for the population she serves. She makes presentations at
local high schools on science and medicine and mentors students through the
Association of American Indian Physicians.
Having a foot in two worlds coupled with a desire to help patients
sustained her through rough patches in medical school, and does so today, she
said. "I can see both the Navajo and the Western points of view, and
that has given me a more holistic world view and made me more accepting of
people's differences." ▪