Trauma lies behind much of the disproportionate levels of psychiatric and
physical illness in American-Indian and Alaska-Native populations, but how far
behind depends on who is talking.
High rates of road accidents, suicide, diabetes, alcoholism, and other
forms of premature death and illness among these populations arise from
historical trauma—"cumulative emotional and psychological wounding
over lifetimes and across generations," according to Maria Yellow Horse
Brave Heart, Ph.D., an associate professor at the Columbia University School
of Social Work. She is a member of the Hunkpapa and Oglala Lakota tribes.
Five hundred years of conquest, expulsion, death, cultural deprivation, and
mistreatment have left North American native populations with much unresolved
grief about their history, which must be openly discussed if it is to be
resolved, she said at the annual meeting of the National Association for Rural
Mental Health in Albuquerque in June.
Bearing that grief, they often retreat into the past as a form of
avoidance, fantasizing about reuniting with their ancestors. The trauma
doesn't merely affect those who experienced it firsthand but is passed down to
succeeding generations who can't escape its clutches, said Brave Heart, who
derives much of the theoretical underpinning for her views from studies of
survivors of the European Jewish Holocaust and their children.
"Historical trauma is like complicated grief, full of yearnings and
guilt feelings," said Brave Heart of the experiences of North American
native populations. "People think that if they are not suffering, they
are not being loyal to their ancestors."
Spero Manson, Ph.D.: The trauma of contemporary life has a greater
effect on the well-being of American Indians than does historical
Credit: Aaron Levin
However, medical anthropologist Spero Manson, Ph.D., draws much different
conclusions from his own epidemiological studies of trauma in American-Indian
populations. What people living today experience counts more than what
happened to their ancestors, he said at the
"Historical trauma, secondary traumatization, and intergenerational
grief need to be examined rigorously, but I think they make only a modest
contribution to risk compared to current trauma," said Manson, a Pembina
Chippewa and a professor of psychiatry and head of the American Indian and
Alaska Native Programs at the University of Colorado Health Sciences Center in
Manson and colleagues studied psychiatric epidemiology and mental health
service use among 3,084 members of two tribal groups in the Southwest and the
Northern plains from 1997 to 1999. They found overall lifetime rates of
exposure to trauma of 63 percent to 70 percent, depending on location. These
were higher than the rates in the general U.S. population of 61 percent for
men and 51 percent for women, as determined through the National Comorbidity
Survey. Notably, trauma rates for men and women among the tribal populations
were roughly equal, unlike in the general population.
Physical abuse that was nonsexual led to more psychiatric or emotional
problems in the study populations than did sexual abuse, with alcohol often a
contributing factor to violence or injury. Since 40 percent of primary care
complaints in this population involve pain, physical abuse may serve as the
factor connecting trauma to pain, he said. Trauma was also associated with
risk for and high rates of onset and poor control of diabetes, asthma, and
chronic obstructive pulmonary disease.
Giving focused attention to preventing and treating trauma would ameliorate
its physical and psychological sequelae, said Manson. "We can draw on
local solutions for local problems, despite the chronic and debilitating
nature of trauma."
In addition, more research is needed to justify new programs such as
telehealth systems and to systematically address and care for these types of
problems, he said.
For her part, in 1992 Brave Heart founded the Takini Network, an
organization that promotes community healing from the intergenerational trauma
she has identified. She has conducted more than 200 talks and training
sessions in the United States and Canada. They have helped communities
acknowledge and understand the history behind their current social and
psychological problems, she said. ▪