Indigenous Mental Health - American Psychological Association

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SPECIAL SECTION TABLE OF CONTENTS INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I OVERVIEWS Is There Such a Thing as Indigenous Mental Health? Implications for Research, Education, Practice and Policy-making in Psychology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . III Promoting the Wellbeing of Indigenous People in Mental Health and Education. . . . . . . . . . . . . . . . . . . . VII CULTURAL, HISTORICAL, AND SPIRITUAL ISSUES The Chamorro People of Guam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XIII Unbodies of Water: The Health Effects of Extinction and Genocide — Arawak Perspectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XVII The Indigenous Peoples of Alaska: Appreciating the Role of Elders in Shifting Toward a Strength-Based and Culturally-Appropriate Approach to Mental Health. . . . . . . . . . . . . . . . . XXIII Indigenous Healing en La Comunidad Latina. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XXVIII Contextual Understanding of Two-Spirit Peoplehood.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XXXII GUIDANCE FOR CLINICAL PRACTICE Pivotal Protocols: The Spirit Dimension in Indigenous and Western Psychologies. . . . . . . . . . XXXV Cultural Health Beliefs and Conceptualization of Illnesses Among Haitians. . . . . . . . . . . . . . . . . XLI Respecting Traditional Healing: A Journey of Understanding Where Spirituality and Cultural Competence Intersect. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XLVI EXEMPLARY TARGETED INTERVENTIONS Legislative Efforts to Eliminate Native-Themed Mascots, Nicknames, and Logos: Slow but Steady Progress Post-APA Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . XLVIII Wuyámush (Be Happy, Be Well – Pequot): Adapting a Mental Health and Healing Experience to a Southeast New England Native American Community. . . . . . . . . . . LV Honoring Children, Making Relatives: Indigenous Traditional Parenting Practices Compatible With Evidence-based Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LX Teaching American Indian Children about Mental Illness: Developing a Culturally Sensitive Curriculum about the Science of Mental Illness.. . . . . . . . . . LXIV The Society of Indian Psychologists. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LXIX

Introduction We Bear the Fruits of Our Histories Bertha G. Holliday We bear the fruits of our histories. Indeed, our post-modern world is shaped and defined by the contacts that Europeans initiated with other cultures throughout the world during the 15 th through 19 th centuries. Those contacts were not merely adventuresome and exploratory: They were deliberate conquests of land, resources, people, and cultures with the intent of transforming and using all of these for the benefit of the conqueror and his/her and enrichment and empowerment. Such intents, as conquerors are well aware, are always met with resistance — hence the need for oppression of “conquered” people and cultures. We now recognize that the scars and wounds of oppression on descendants of both the conquerors and the indigenous people and cultures “conquered”, as well as their multi- racial/ethnic/cultural descendants , are profound and multi-generational, resulting in continuous enactments of micro and macro symbolic and psychological vignettes of the original conquest/resistance. We bear the fruits of our histories. We further have come to recognize that despite oppression and its historical trauma, globalism, instant world communication, Madison Avenue — people and their cultures are durable, resilient, and persistent yet adaptable. And it is these characteristics — in the face of the legacies of conquests, trauma, and social-historical transformations, — that are at the nexus of health and well-being. Cultural beliefs and practices, family, kingroup, and ancestors are the “source” to which many return for centeredness, authenticity, and strength. And nowhere is this more vividly clear than in the responses of the world’s indigenous peoples to their current challenges related to psychological healing and well-being. This special section seeks to increase psychologists’ understanding of such issues. Three months ago, OEMA disseminated a call for brief articles: W e seek papers from psychologists that address 2 or more of the following issues: (a) the history and culture of an indigenous culture; (b) the contemporary challenges faced by that culture and related effects on mental illness and well-being; (c) traditional indigenous perspectives on mental illness, mental health and/or other "special" populations (e.g., lesbian/gay/bisexual, elders, persons with disabilities, etc.); (d) contemporary culture-specific practices (i.e., those that are responsive to traditional beliefs and practices) for the treatment and/or promotion of well-being of persons with mental illness or other "special" populations; and, (e) related implications for psychological research, training and practice.

The response was unexpected in its enthusiasm, enabling OEMA to produce this Special Section of 15 articles. Collectively, these articles are broad in scope, describing a panorama of indigenous cultures throughout the Americas and the Caribbean and their approaches to healing and well-being. Among the indigenous groups addressed are Alaska Natives, American Indians, Arawaks, Chamorros of Guam, First Nations people of Canada, Haitians, Latinos of Cuba, and others. Equally as varied are the specific topical foci of the articles. But what is most striking is the communality of themes and concerns across the various articles and cultural groups, and the differences between these communalities and major thematic concerns of Western (U.S.) psychology. The Special Section is divided into four subsections focusing on: (a) overviews of indigenous mental health issues and related implications for psychology; (b) critical indigenous cultural, historical, and spiritual issues; (c) guidance for clinical practice with indigenous peoples; and, (d) exemplary targeted interventions. OEMA hopes this Special Section will promote increased multiculturalism in psychological education and training, research, practice, and advocacy. Doing so is an imperative, as we bear the fruits of our histories.

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OVERVIEWS

Is There Such a Thing as Indigenous Mental Health? Implications for Research, Education, Practice and Policy-making in Psychology Carlota Ocampo, PhD Washington Trinity University 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 Carlota Ocampo, PhD 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 …our mental health frameworks, when has been largely focused on non-Indigenous, applied among First peoples, may result rather than Indigenous, notions of health" in further trauma and perpetuate, rather (King, Smith & Gracey, 2009), while at the than address, their problems. 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, -III-

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.)

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

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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 -IV-

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.

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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.

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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 Indigenous people are just as much a part health? I hold that we do not yet fully know of the complex modern world as any of what such a construct will look like, other us, and Indigenous psychologies are equally complex and important. They may than restoration of the Indigenous to an not look like our psychologies; they may u n co lon ize d state. Y et even this be different, they may be unique, but they conceptualization has its limitations - it must must be nurtured, respected and allowed not be viewed through the lens of romantic to emerge. A key concept psychology naivete which many in our mainstream must focus on in Indigenous mental culture use to gaze in simplistic nostalgia on health: empowerment. 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 -V-

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, 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.

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Promoting the Wellbeing of Indigenous People in Mental Health and Education Innocent F. Okozi, MA, EdS Chair, APAGS – CEMA, Seton Hall University Andrea Zainab Nael, MEd APAGS-CEMA – Oklahoma State University Maria Cristina Cruza-Guet, MEd APAGS Member at Large – Lehigh University Historically, American Indians have been victimized and discriminated against by generations of immigrants as well as Federal and State governments (Yellow Bird, 2006). Unjust and demeaning acts committed against this ethnic group include the forceful seizure of their lands and resources, attempts to eliminate their cultural heritage, broken promises and breach of contracts, wars, and betrayals of trust (Yellow Bird, 2006). Even though overt discrimination against this cultural and ethnic group Innocent F. Okozi, MA, EdS is illegal, it is still possible to identify vestiges of oppression toward American Indians in current educational and mental health practices. Thus, the purpose of this article is to highlight some contemporary challenges facing indigenous peoples including American Indians and Alaskan Natives. In addition, we will outline some strategies to begin addressing these problems. Socioeconomic and Health Disparities The United Nations Development Program noted that the countries regarded as the developed world are consistently at the top of the Human Development Index (HDI), which is a measure of the economic, educational, and health status of a population (Webber, 2007). However, the indigenous peoples residing in these developed nations exhibit poorer health and live in conditions that are substandard than those of their non-indigenous counterparts

According to SAMHSA's statistics, the American Indians and Alaska Natives face multiple challenges such as: (a) suicide rates that are more than twice the national average, (b) pervasive substance abuse problems (e.g., more than 70% of the mentally ill indigenous population suffer from an addiction), (c) inadequate financial resources to respond to the needs of this population, and (d) lack of family and consumer support services…

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(Webber, 2007). In the United States, the American Indians and Alaska Natives are among the populations identified as being disproportionately affected by health disparities (Office of Minority Health and Health Disparities: OMHD, 2009). According to SAMHSA's statistics, the American Indians and Alaska Natives face multiple challenges such as: (a) suicide rates that are more than twice the national average, (b) pervasive substance abuse problems (e.g., more than 70% of the mentally ill indigenous population suffer from an addiction), (c) inadequate financial resources to respond to the needs of this population, and (d) lack of family and consumer support services in their communities (Bearsheild, Dolchok, & Griffin, 1993). Educational Obstacles

Andrea Zainab Nael, MEd

Sadly, it is not only American Indian and Alaska Native adults who are affected by social challenges, but also their children and families (Bearsheild, Dolchok, & Griffin, 1993). In a recent survey, school teachers from South Dakota and Montana were asked to report the obstacles faced by American Indian students. Results of this survey indicated that American Indian students experience pressure to assimilate the American dominant culture, while remaining loyal to their own traditions (Werdel, 2010). According to this survey, American Indian students also experience oppression and are the subject of cultural misunderstandings. Further, their educational development is hampered by the negative attitudes of parents and/or grandparents towards the formal education system (Werdel, 2010).

The attitudes of parents and grandparents are In fact, only 7 % of American Indian often based on negative, but real personal students attending postsecondary experiences and poor educational outcomes. institutions graduate annually (Office of In fact, only 7 % of American Indian Educational Research and Improvement, students attending postsecondary institutions 2003). graduate annually (Office of Educational Research and Improvement, 2003). This statistic illustrates the often insurmountable difficulties that this population encounters in educational institutions. Other reasons for the low educational outcomes are related to socioeconomic disadvantages, disparities in access to educational resources and differences in learning styles. Research studies show that American Indians and Alaska Natives prefer

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concrete experiences and reflective observation as their primary means of learning (Ornstein, and Hunkins, 2004). Unfortunately, most educational institutions still maintain Eurocentric methods of teaching that do not benefit ethnic minorities. Challenges Related to Mental Health Systems American Indians have not received enough attention in the mental health area. Their worldviews regarding mental illness and healing have been frequently ignored in the psychological and psychiatric literature. It was only in the early 1990's, for instance, that the American Psychiatric Association began placing more emphasis on investigating this ethnic group's understanding of mental illness, and systematically incorporating relevant information in its publications (Mezzich, Kleinman, Fabrega, & Parron, 1996). In 1994, an appendix on culturally-bound syndromes was included in the fourth revision of the Diagnosis and Statistical Manual in an attempt to address the gap between Indigenous and Western practices, (Mezzich et al., 1996). In 2002, the American Psychological Association (APA) approved a set of Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2003) to ensure that American Indian and Alaska Natives (and other minority groups) receive appropriate psychological services. Although current psychological American Indians and Alaska Natives… practices strive to advocate and understand "wellness" holistically, that is, in promote the wellbeing of indigenous terms of a combination of physical, mental, people, the methods utilized by emotional, and spiritual elements. Illness is seen psychologists have historically as an imbalance between these basic elements…Healing practices …attempt to restore failed to take into account the the natural balance…through spiritual ceremonies beliefs about health and healing held and herbal remedies…Treatment for mental by this population. American illness also revolves around storytelling, teaching Indians and Alaska Natives, as many and sharing circles, sweat lodges, and vision other indigenous peoples throughout quests. the world, understand "wellness" holistically, that is, in terms of a combination of physical, mental, emotional, and spiritual elements (Patel, 1995; Rice, 2003). Illness is seen as an imbalance among these basic elements that is brought about by ancestral spirits, bad airs, and witchcraft. Healing practices, on the other hand, attempt to restore the natural balance among soul, mind, and body through spiritual ceremonies and herbal remedies prescribed by community elders and cultural healers (Poonwassi & Charter, 2005). Treatment for mental illness also revolves around storytelling, teaching and sharing circles, sweat lodges, and vision quests (Poonwassi and Charter, 2005). In spite of marked

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differences between indigenous healing practices and traditional psychology, as illustrated in these examples, the Western study of mental illness has rarely considered cultural or contextual factors in its conceptualization, diagnosis, and treatment (Mezzich, Berganza, & Ruiperez, 2001). What Psychologists Can Do? American Indians and Alaska Natives are resourceful and resilient. Despite the insidious and persistent predicaments that they have experienced, they continue to strive to maintain their cultural identities and heritage as well as overcome the socio-economic challenges impacting their communities. In the 21st century, much effort is required to address the social issues affecting indigenous peoples. The responsibility for the improvement of the psychological and physical wellbeing of these people should be, however, shared by everyone. Maria Cristina Cruza-Guet,

Psychologists working in educational institutions can promote MEd a welcoming environment for indigenous peoples and develop programs of study that are relevant to the growth of their communities. Studies have shown that American Indians and Alaska Natives benefit from educational environments that are consistent with their cultural norms and are respectful of their ethnic identity (Korkow, 2009). Their level of connectedness with their families and communities has been identified as a persistent factor for staying in college until graduation (Guillory, 2003). Further, research assessing what motivates American Indians to attend college suggests that they hold a desire to "give back" to their communities upon the completion of their degrees (Guillory, 2010). Specifically, they want to help their families to escape poverty and unemployment (Brown and Lavish, 2006). Psychologists working in governmental and philanthropic institutions can continue creating and implementing programs that facilitate the development of researchers and clinicians with expertise in indigenous people. SAMHSA and other governmental (Federal, State and Tribal) agencies already support the educational initiatives of students from indigenous backgrounds. An example of this type of programming is that of Werdel (2010), who set out to implement a strategic plan that facilitates the recruitment and retention of American Indian students in the South Dakota region. Funded by the US Department of Education, this strategic plan attempts to (a) increase academic achievement, (b) improve the recruitment and retention of highly qualified teachers, (c) integrate the local culture (Lakota-Dakota-Nakota) into the State Standards of education, and (d) develop a dynamic informational website regarding American Indian education in South Dakota. -X-

Psychologists working in clinical settings can improve their efficacy in working with indigenous peoples by familiarizing themselves with the belief systems and treatments of mental illness utilized by these varied populations. It is our hope the APA continues to foster partnership programs that facilitate access to mental healthcare and the education of students from indigenous backgrounds. We encourage APAGS members to strive to complete their externships and/or internships in regions identified with indigenous populations, as well as to participate in the mentoring of American Indian and Alaska Native students. We encourage both psychologists and APAGS members to firmly commit to promoting the well being of these populations. References American Psychological Association. (2003). Guidelines for multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377-402. Bearsheild, W., Dolchok, M., & Griffin, R. (2010). The journey of Native American people with serious mental illness executive summary. Retrieved 06/06/10 from http://mentalhealth.samhsa.gov/publications/allpubs/CS00-0003/resolution1.asp Brown, C., Lavish, & L. A. (2006). Career assessment with Native Americans: Role salience and career decision-making self-efficacy. Journal of Career Assessment, 14(1). Campion, J. & Bhugra, D. (1998). Religious and indigenous treatment of mental illness in South India- a descriptive study, Mental Health, Religion & Culture 1(1), 21-29. Centers for Disease Control and Prevention (CDC). (2009). Office of Minority Health and Health Disparities (OMHD): An overview. PowerPoint presentation on OMHD. Retrieved November 16, 2009, from http://www.cdc.gov/omhd/About/about.htm#Reorganization Guillory, J. P. (2010). Diverse pathways of "giving back" to tribal community: Perceptions of Native American college graduates. Dissertation Abstracts International Section A: Humanities and Social Sciences, 33-66. Guillory, R. M. (2003). Factors related to Native American students' persistence in higher education: A comparative analysis of student and state and university officials' perceptions. Dissertation Abstracts International Section A: Humanities and Social Sciences, 24-57. Indian Nations at Risk Task Force, US Department of Education. (1991, October). Indian Nations at risk: An educational strategy for action. 70 pp. Retrieved 06/06/10 from http://www.tedna.org/pubs/nationsatrisk.pdf Korkow, J. (2009). Native American success in college. Dissertation Abstracts International Section A: Humanities and Social Sciences, 38-56. Mezzich, J.E., Berganza, C.E. & Ruiperez, M.A. (2001). Culture in the DSM-IV, ICD-10, and evolving diagnostic systems. Cultural psychiatry: International perspectives. The Psychiatric Clinics of North America, 24, 407-419. Mezzich, J.E., Kleinman, A., Fabrega, H., & Parron, D.L. (Eds.). (1996). Culture and psychiatric diagnosis: A DSM-IV perspective. Washington, DC: American Psychiatric Press.

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Office of Educational Research and Improvement (OERI). (2003). The Bridge Project: A Project of the Stanford Institute for Higher Education Research. Retrieved June 6, 2010, from http://www.stanford.edu/group/bridgeproject/bridge_brochure.pdf Ornstein, A., & Hunkins, R. (2004). Curriculum, 4th ed. Boston: Pearson Education. Patel V. (1995). Spiritual distress: An indigenous model of nonpsychotic mental illness in primary care in Harare, Zimbabwe. Acta Psychiatr Scand, 92, 103-107. Poonwassi, A. & Charter, A. (2005). Aboriginal worldviews on healing: Inclusion, blending and mending. In: Integrating Traditional Healing Practices into Counseling and Psychotherapy. Thousand Oaks, CA: Sage. Rice, B. (2003). Articulating Aboriginal paradigms: Implications for aboriginal social work practice. Native Social Work Journal, 5, 87-97. Webber, B. (2007, Dec). Improving quality of life for indigenous peoples. Medical News Today. Retrieved 06/06/10 from http://www.medicalnewstoday.com/articles/92358.php Werdel, L. (2010). Letter from the director. Retrieved 06/06/10 from http://doe.sd.gov/secretary/indianed/index.asp Yellow Bird, M. (2006, June 30). Yellow Bird: Open letter to all indigenous peoples. Retrieved 06/06/10 from http://www.coloradoaim.org/blog/2006/06/yellow-birdopen-letter-to-all.html. Innocent F. Okozi, MA, EdS is graduating in August 2010 from the Counseling Psychology program at Seton Hall University, NJ. He is the Chair of APAGS Committee on Ethnic Minority Affairs (CEMA) from 2008-2010. Andrea Zainab Nael, MEd is a third-year doctoral student at Oklahoma State University. As a Regional Diversity Coordinator for APAGS CEMA, she was involved in the outreach program for the ethnic minority graduate students in her region. She is a Fellow of APA's Minority Fellowship Program. Maria Cristina Cruza-Guet, MEd is currently a post-doctoral fellow at Yale University Department of Psychiatry. She was a Regional Diversity Coordinator for APAGS CEMA from 2007 to 2009. She is currently the APAGS Member at Large - Communication Focus.

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CULTURAL, HISTORICAL, AND SPIRITUAL ISSUES

The Chamorro People of Guam Patricia L. G. Taimanglo, PhD Tamuning, Guam Chamorros are the indigenous people of the Mariana Islands of which Guam is the largest and southernmost on an island chain. Archeological evidence identified civilization dating back 5,000 years. Historical Background In recorded history, the Chamorro people have, as a community experienced traumatic periods that remain unresolved (Pier, 1998). These include the near total genocide and colonization by the Spanish (1521-1898). It had been a possession of the United States from 1898 to 1941 until Guam was attacked and occupied by Japanese forces from 1941–1944. The island was once again assaulted by the United States to recover Guam from the Japanese, but what followed was more destructive than any of actions made on the island previously, including death and destruction wrought by war. It was reoccupied in 1944 and in 1950 became an unincorporated territory of the United States. Consequently, Guam is one of the few remaining colonies of the world and as a colony has no power. The destructive effects of colonization, …the current political status include possession, and Guam's current political numerous losses —especially the loss of the status include numerous losses — cultural practices such as the arts, crafts, and especially the loss of the cultural those practices passed on by men…The loss of the language was destructive to their practices such as the arts, crafts, and identity…Loss of the Chamorro people's those practices passed on by men, as the voices continue to be evidenced as their focus of genocide was directed toward concerns are consistently ignored and their control and elimination. The silenced throughout history. Worst yet, they gradual elimination of the dances, are not invited or considered in the current chants, and songs of the past was also arena in which the United States and Japan are at the table deciding the destiny of the painfully noted. The loss of the island… language was destructive to their identity and how Chamorros viewed themselves within the dominant culture, as English was strictly imposed as the language of instruction and business. Loss of the Chamorro people's voices continue to be evidenced as their concerns are consistently ignored and silenced throughout history. Worst yet, they are not invited or considered in the current

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arena in which the United States and Japan are at the table deciding the destiny of the island without regard to the effect on the people of Guam and specifically on the Chamorros. This loss of power is one of the most destructive effects of colonization. Current Predicament

Patricia L. G. Taim anglo, PhD

Negotiations have been waged between the United States and Japan in the last few years and most significantly in this last year. The focus had been the relocation of 8,000 Marines and their dependents from Okinawa to Guam. These negotiations are without input from the indigenous people of Guam. In order to accomplish this massive build-up, the U.S. military will require the importation of people to make the relocation possible. In other words, the build-up includes a projected population increase by some 80,000 people in 2014. This constitutes a 45% increase from Guam's current population of 180,000 people.

The federal Environmental Protection Agency has stated their concerns related to the significant and adverse environmental and social impact. The social impact includes overcrowding and over use of limited resources including the educational system, as well as social/human service agencies. Competition for housing, jobs, medical care, psychological and psychiatric care will further exaggerate the gap between that haves and the have nots. In addition, the plans for the build-up include taking of more land. Most indigenous people have a deeply The projected land taking includes taking rooted and emotional relationship to the land in an area called Pagat. This location land and sea. Both provide sustenance; encompasses the richest and largest hold the stories and way of life of the archeological evidence of the Chamorro people, their way of life, as well as a fresh people that are passed on from one water source. Incredibly, this land is generation to the next. The projected land earmarked for use as a firing range. taking includes taking land in an area called Pagat. This location encompasses the richest and largest archeological evidence of the Chamorro people, their way of life, as well as a fresh water source. Incredibly, this land is earmarked for use as a firing range. The disregard for the meaning of such sacred sites is abhorrent to the people of Guam and has been the focus of the collective and historical hurts and energies.

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Open forums to educate the islanders of the impending change evidenced calmly articulated responses to highly and emotionally charged accounts of why the islanders are in favor of or in opposition to the military build-up. Interestingly, these forums were scheduled after decisions have been made about the build-up. Social and Cultural Responses: Pathways to Healing Some Chamorro people sleep soundly on the pillows of denial, lack of awareness, and/or struggling to meet their family's basic needs. Others work intensely to address the history of losses and to the meet the challenges of the present and future. To address the loss of language, Chamorro language instruction is a part of the educational curriculum in the public schools. Chamorro language competitions are held annually. To address the loss of cultural practices, a cultural renaissance is evidenced in the use and making of shell jewelry by artists whose art is based on archeological evidence. Several cultural groups that nurture the development of a positive ethnic and cultural identity have blossomed throughout the island. These groups encourage the youth and adults to learn about the Chamorro history, culture, songs, and dances. Such groups also provide a natural venue to practice and speak Chamorro. Cultural activists have been a part of island life over the years, however, the need to address concerns were not wholly embraced by all members of the Chamorro community. Ironically, the anticipated military build-up has elicited growing collective voices and presence of young and older Chamorro people who are willing to share their thoughts and feelings from a passionate as well as objective perspective. The act of speaking out, although historically viewed as negative behavior within the Chamorro culture, is now viewed as acceptable. The young Chamorro people are at a great advantage because they are bicultural and not bound by the strict rules of behavior that include silence and accepting directives from authority without question — both behaviors, ironically, that enabled Chamorros to survive over the centuries. These young people are educated in both cultures, and are armed with the skills of media and technology. In addition, the fourth year of a Chamorro conference that is inclusive of the Chamorros living in the Mariana Islands, is a forum for learning, sharing, and support to nurture a psychologically healthy and informed Chamorro people on Guam and throughout the Mariana Islands.

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The greatest benefit of the military build-up is that people are standing up and expressing their thoughts among themselves but also at national and international forums to inform others of our current plight. It has promoted increased awareness, empowerment — both pathways to healing as a people.

The greatest benefit of the military build-up is that people are standing up and expressing their thoughts…to inform others of our current plight. It has p r om o t e d increased aw areness , empowerment — both pathways to healing as a people.

References Pier, Patricia Taimanglo (1998). An Exploratory Study of Community Trauma and Culturally Responsive Counseling with Chamorro Clients. A dissertation submitted to the Graduate School of the University of Massachusetts, Amherst. Patricia L.G. Taimanglo, PhD is a Chamorro woman of the Island of Guam. She currently resides on her island home and has a vibrant private clinical practice.

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Unbodies of Water: The Health Effects of Extinction and Genocide — Arawak Perspectives 1/ M. C. L. Provost University of Toronto M. Quintana Taíno del Norté Overview Arawaks, one of the first Peoples of the Circum-Caribbean, southern North America, Central America and northern South America, are falsely said to be extinct (Provost, 2001), and this leads to the challenge of non-existence. How can we articulate Arawak perspectives on health if we must conduct our lives in a foreign grammar and language where we must speak of ourselves in the third person? What are the health effects of being extincted? Is extinction the same as genocide? 2/ M. C. L. Provost

The noun genocide refers to mass killings of people on account of their racial origin. The adjective extinct describes beings who were killed off, leaving no living representatives. The verb forms are to extinct and to be extincted. The Arawak language we use is based primarily on J. P. Bennett's (1984; 1994) language work. In that language, extinction might be translated as yakosa – to extinguish (the fire/life literally, "resemble/allow eye" – a type of 'heart'). From this comes yakosahe – the state of being extinguished (homicide); and, yakosoa – to extinguish oneself (suicide). Yakosa is related to yahoda - to die, and aiyada - to weep. Wholeness of 'eye-heart' is key to Arawak well-being. The language provides a kind of sonographic ecology through myth and song, so that being "out-of-[eye-]heart" has an adverse health effect (Taylor, 1951), as in Guahayona's story below.

1/

Portions of this paper were previously presented at side events of the 6th session (2007) of the United Nations Permanent Forum on Indigenous Peoples I and the 9th Session (2010) of the United Nations Permanent Forum on Indigenous Issues.

2/

United Nations Convention on Genocide, Article 2 (1948), includes 5 areas that apply to cultural genocide.

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M. Quintana

The challenges to achieving this ecology of healthfulness began with the invasions of foreign Empires (i.e., Spain, France, Portugal, Netherlands, & Britain) at First Contact (1492). Each invasion was like the collision of two tectonic plates of Earth's surface breaking or shifting then colliding (Provost & Quintana, 2007). Earth is alive and earthquakes and aftershocks are evidence of her search for balance and equilibrium. But the cumulative damage of earthquakes increases in logarithmic increments, not by simple multiplication. Arawak identity is closely linked with all bodies of water and a waterquake would be a hurricane (Húrakan — a Divine name and attribute).

The Problem of Non-Existence: Zombification Genocide psychology is well known from stories of the Holocaust, but Extinction creates extreme difficulty in telling one's story, particularly in one's occupied homelands. The closest analogy is zombification. A zombie is a 'living-dead' – an unbody – created in one of two ways: (a) the zombies of Vodun by use of Tetradotoxin from the Puffer Fish;3/ or (b) the zombies by isolation from one's home-family culture and socialization to an alien one.

…Extinction creates extreme difficulty in telling one's story, particularly in one's occupied homelands. The closest analogy is zombification. A zombie is a 'living-dead' – an unbody – created in one of two ways: (a) the zombies of Vodun by use of Tetradotoxin from the Puffer Fish ; or (b) the zombies by isolation from one's home-family culture and socialization to an alien one.

Similar violations and traumas occur in both forms, rupturing the self and its relationships. Zombies must live in this world without being of this world, as they do not really exist and are 'not-human' beings and this causes a sense of disembodiment.

3/

Vodum, though commonly known as a Afro-Caribbean religion, is actually a syncretism of Arawak with African and Christian iconography, known across the region also by other names. Tetradotoxin reduces bodily functions to an imperceptible state so that the individual, appearing dead, could be buried alive but may be exhumed and enslaved. Tetradotoxin use was publicized by W . Davis (1994) in Passage of Darkness, based on his work for an American pharmaceutical firm — but from indigenous perspectives, his report was a form of theft.

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The Colonial Disease The Colonial Disease — our term for the The Colonial Disease — our term for the spectrum of ill-being due to the spectrum of ill-being due to the Euro-colonial social experiment — Euro-colonial social experiment — negatively impacts all the social negatively impacts all the social determinants of health due to a several determinants of health due to a several factors: identity-loss; substance abuse; factors: identity-loss; substance abuse; changes in diet, lifestyle and changes in diet, lifestyle and environment; environment; pollution, and gender pollution, and gender construction which construction which may be imposed or may be imposed or self-initiated as self-initiated as life-strategies of last life-strategies of last resort. The "cure" for resort. The "cure" for the Colonial Disease always involves some form of the Colonial Disease always involves ceremonial self-recovery through some form of ceremonial self-recovery self-study of the languages, storying-arts, through self-study of the languages, and environmental knowledge. s to ryin g -a rts , a n d e n v iro n m e n ta l knowledge. We describe the Arawak sense of Participation as Imekohe andábo kake — "Willingly joining together for life, we awaken" -with an agitated awareness and an impetus to learn. Imekohe andábo kake korokodawa involves becoming whole in heart, as well as a moment when we ceremonially enact the myths across the generations. Then, positive emotions evoked by ceremonial tribal family arts rekindle the fires of the Ancestors and the Divine in our own shared embodied 4/ myth-dreams. This Arawak deeper-identity is heard throughout the myths (Provost & Quintana, 2009). We have seen that Arawak grandparents and great-grandparents, who live generally healthy and well-adjusted lives in the Hinterlands of Guyana, do still possess a certain level of immunity and resistance to the Colonial Disease. Their environment and ways of life make this possible, even though they honor their adopted religions alongside their Indigenous beliefs. The grandparents see the Colonial Disease as a threat to the younger generations while the young may not yet perceive it as such. The young tend to begin losing their Arawak identity (i.e., attachment) as they come under the illusions of affluence (i.e., individuation) through education and schooling in European /non indigenous languages, entertainment or work.

4/

The body tends to respond to learning the arts with health-producing chemical reactions rather than toxic ones, with a resulting sense of loving oneself, others, and of being loved. Arts therapies and arts interventions have therefore become a growing trend amongst non-natives.

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The Example of Guahayona's Story The Family Principle of Giving is expressed in different ways but as Imekohe andábo kake korokodawa, it is violated in Guahayona's story as reported by Ramón Pané: Guahayona (literally "we cried [for] them"), the brother of an Arawak chief, sent one of the men to gather digo (an herb used for healing skin conditions and curative baths by Surinam Arawaks) … Later Guahayona said to the women in Cauta (a place where Cauta trees grow, which have inedible fruit and resemble another tree with edible fruit), "Leave your husbands … leave your little ones (here by the stream) … I will come back for them, and we will take with us only the güeyo" (coco plant — once a staple food — but now cocaine is made from it). Guahayona took the women to Matinino (literally "Without Fathers") island and abandoned them there. He did not go back for the children. The little children abandoned by their mothers were hungry and began crying out for food. And so they became frogs, who cry until this day"Toa, toa, toa" (a term for self, the eye-heart, food for a journey, the song of frogs and thunder). A while later, Guahayona becomes ill and Guabonito (Deep Waters Woman), a celibate, teaches him how to heal by bathing in the sea. He goes to live with his father Hiauno (the name for an aggressive predator parrot) and takes a new name: Albeborael Guahayona (translated by some — as "henceforward Guahayona" — but the authors transliterate the name as "Steals + We Cry [for] Them") and then he brings all knowledge to future generations. What is wrong with this picture? Knowing our story-patterns and the nature of myth, we can distinguish various editorial impositions by Ramón Pané, a Catalan friar, and subsequent writers. Let us review: Traditionally, the woman's and man's voice would be present for balance and to avoid invalidity, but the woman's perspective is missing throughout Pané's account. Guahayona also breaks all the traditional principles. He deposed his own brother, misused his knowledge of Arawak Healing Medicines by over-harvesting güeyo and digo, and taking much of the 'medicine' of guanin (a precious metal) from the island of the same name. He misused his charisma to manipulate the women into deceiving themselves, by drawing upon their love for child and family, so that they abandoned their husbands and children. But he departed from the teachings of family and so his immune system attacked him and ego-greed manifested itself in his illness. The children, abandoned, regress to a pre-verbal animal state. The abandoned women have no way to recover their families or to begin new ones. The abandoned husbands lose their sense of being spouses and fathers. Guahayona, a self-appointed messiah-type, overcomes his infirmities and returns to live in his father's home. Enter the idea of celibacy in a place of solitude and a means for healing the disrupted self. But this is not a teaching for Arawak health; it is a Catholic religious intervention — and these types of transformations create individual and cultural invalidity. -XX-

Pané and later writers, in demonizing Arawak sexuality and family life, wrongly assume Guahayona's disease is syphilis; this is evident from a closer reading. Guabonito's prescription that the ill Guahayona bathe in the sea subsumes Arawak ritual bathing in Catholic baptism, yet he becomes mysteriously healed of his sores. After his spiritual rebirth, Guabonito presents him with gifts of guanin and ciba (precious stones) and he is cast as a hero to his People. But the missing children — embodiments of the fire of eye-heart — are never found. The women, exiled in a place without spouses or children become a type of the celibate woman Guabonito. This is the ideal of La Virgen (Spanish – the Virgin) for whom self-annihilation involves giving up her child and husband. But in pursuing their personal good as being for the good of all, the women and Guahayona have forsaken the reality that: "Willingly joining together for life, we awaken". The result is ill-health and ill-being for all except Guahayona who eventually becomes a self-made man. Breaking the principle of Breaking the principle of family health perpetuates family health perpetuates Extinction. Arawak self-identity embodies deep and Extinction. Arawak multi-faceted relations with ancestors, family members, the environment and cosmos, with whom we are one being. self-identity embodies deep Andábo (joining) creates individual self-identities as well as and multi-faceted relations family self-identities, simultaneously. But separating the with ancestors, family family (individuating) creates self-annihilation. members, the environment and cosmos, with whom we are one being. Andábo (joining) creates individual self-identities as well as family self-identities, simultaneously. But separating the family (individuating) creates self-annihilation. The Colonial Disease does result in non-existence, death and dismemberment, orphaning, alienation and wounding. And because many of us are now a people of mixed-blood-and-culture, we must balance fragmented and divided identities. Thus an Arawak faces many deaths in Eurocentric society as her/his 'joining' self becomes socialized to 'separating'. An Arawak also has several other 'hearts' as we discuss elsewhere. Losing any one of these 'hearts' is like experiencing brain-death, cardiac-death or spiritual-death. Arawaks can hope to achieve health where Earth is also 'heart', for wholeness requires that we willingly join together for life and awaken — wa'imekohe andá kake korokoda. References Audiovisual Library of International Law. United Nations. (1948) Paris. "Convention on the Prevention and Punishment of the C ri m e of Genocide". (Online: http://untreaty.un.org/cod/avl/ha/cppcg/cppcg.html) Bennett, J. P. (1984; 1994). Arawak English Dictionary. Georgetown, Guyana: Walter Roth Museum. -XXI-

Davis, W. (1988) Passage of Darkness: The Ethnobiology of the Hatian Zombie. Chapel Hill, North Carolina: University of North Carolina Press. DeFilipps, R,, Maina, S. and Crepin, J. (2004). Medicinal Plants of the Guianas (Guyana, Surinam, French Guiana). Dept. of Botany, National Museum of Natural History, Smithsonian Institution: Washington, DC. (Retrieved Online May 28, 2010, Patnic-AG Technical Services: http://patnic.org/documents/Guyplants.pdf) Desmangles, L. (1992). Faces of the Gods: Vodou and Roman Catholicism in Haiti. Chapel Hill, North Carolina: University of North Carolina Press. Pané, R. (1498; 1999). Arrom, J. (Trans.) Relación acerca de las Antigüedades de Los Indios. Duke University Press: London & Durham. Provost, M. C. L., Quintana, M. & Feng, I. (2010). Who Are You Really, Anyway? — Indigenous Self-Study, Self-Identity, Learning &Patterning in Our Mother Language. United Nations Permanent Forum on Indigenous Peoples, Ninth Session: New York City. Provost, M. C. L. & Quintana, M. (2009). Learning to Pattern: "Jumping Over" Stories in Taíno and Other Multi-racial Childhoods. In Findlay, R. (Ed.) "L'adulte en miniature : une vie privée d'enfance". Civilisations/Civilizations Review. no. 9. Toulouse: Presses de l'Université des Sciences Sociales de Toulouse. Paris, France. Chapter. Provost, M. C. L. & Quintana, M. (2007). "Jumping Over Stories": Bauxite and Cassava Cultural Management. Side Event. United Nations Permanent Forum on Indigenous Peoples. New York. Indigenous Teaching and Learning Circle. Online: April 162010 at http://purl.oise.utoronto.ca/itle Provost, Turchetti, L. (2000), When Earth Becomes Heart. Seventh Annual Stabilizing Indigenous Language Conference Proceedings, St. John's N. B Author-Presenter. Taylor, D. (1951). The Black Carib of British Honduras (now known as Belize). Viking Fund Publications in Anthropology, No. 17. New York: Wenner-Gren Foundation. M. Christine Lois Provost is a Taíno Arawak mother of Xamaykano ancestry (Jamaica) and storying-artist in education. Since the 1990s , she has dedicated space to patterns of narrative in orature, storying arts and song text of Arawak mixed people for learning to pattern wholeness as wellness in family cultural contexts. She also works in Aboriginal Languages and Literacy, Music Education, Children's Culture, Creativity and Wellness, and Historical Memory connected with the sociology of Indigenous Knowledges, at the University of Toronto where she is a Doctoral candidate (ABD) in Family Sociology and Child-spirit Life. Machisté Quintana, a Taíno Arawak father of Borikano ancestry (Puerto Rico), is a researcher, educator, actor, writer, director and artist. His areas are Arawak and related languages and orature with reference to Indigenous Knowledges and Ways of Life. He has researched the language family for more than thirty years towards re-establishing the spoken form and Myth as Truth, the understanding that within myth is a poetic language of imagery centered around the truths within. As Director of Taíno Del Norte, Inc. in New York City, he has spoken at various institutions on Indigenous Identity and Education

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The Indigenous Peoples of Alaska: Appreciating the Role of Elders in Shifting Toward a Strength-Based and Culturally-Appropriate Approach to Mental Health Jordan Lewis, PhD Tina Marie Woods, MS Ruth Zuniga, MA E. J. R. David, PhD University of Alaska Anchorage Background Although often simplistically regarded as "Alaska Natives," Alaska's indigenous peoples are highly diverse, composed of seven groups including Eskimo (Yup'ik, Cup'ik, Sugpiaq/ Alutiiq, & Inupiaq) Aleut/Unungan, Eyak, Athabascan, Haida, Tlingit, and Tsimshian (Roderick, 2008). Alaska Native peoples have inhabited Alaska for over 10,000 years and depended on the land for resources. The land provided Alaska Native peoples subsistence needs such as food, clothing, and shelter. Thus, Alaska Native values, beliefs, and traditions are geared toward maintaining a respectful and harmonious relationship with the land.

Jordan Lewis, PhD

In the 1700s, Russians, Europeans, and Christian missionaries colonized Alaska. In 1867, Russia sold Alaska to the United States. This colonial history is when Alaska Native peoples began to experience oppression such as Christianization and the loss of their indigenous beliefs, Westernization of their behaviors, values, and ideals through boarding schools, and the slavery of Aleuts in the 1860s and their internment during World War II. Such oppression negatively affected Alaska Native peoples. For instance, prior to Western contact, the Alaska Native population was approximately 100,000. However, after …prior to Western contact, the Alaska Native population was approximately 100,000. However, after the Great Death, the population decreased to 26,000. Furthermore, despite the benefits of the Alaska Native Claims Settlement Act, Alaska Native peoples still lost millions of acres of ancestral land and, consequently, many aspects of their culture that are closely tied to the land. This…oppression, …[is] linked to the mental health issues faced by Alaska Native peoples today.

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the Great Death, the population decreased to 26,000 (Boraas, 1991). Furthermore, despite the benefits of the Alaska Native Claims Settlement Act, Alaska Native peoples still lost millions of acres of ancestral land and, consequently, many aspects of their culture that are closely tied to the land. This historical and contemporary oppression, along with cultural loss, are linked to the mental health issues faced by Alaska Native peoples today (Napoleon, 1996; for a review, see Sullivan & Brems, 1997). Psychological Issues in Alaska Native Communities Significant attention has been paid to the mental health concerns of Alaska Native peoples, with emphasis on alcoholism and suicide. The alcoholism rate among Alaska Native peoples is double the national average (Division of Alcoholism and Drug Abuse, 1999). Alcohol is related to high crime rates (Alaska Department of Health and Social Services, 2007), and Alaska Native peoples experience five times more alcohol-related deaths than any other group (Alaska Behavioral Health Survey, 2002). The suicide rate among Alaska Natives is also twice the national average and 117% Tina M arie W oods, M S higher than any other indigenous American group (Morgan & Freeman, 2009). Relatedly, this group also has high rates of depression and psychological distress (Alaska DHSS, 2007). Among Alaska Native adolescents, high rates of school drop-outs and pregnancies have also been reported (Sullivan & Brems, 1997). However, despite such concerns, Alaska Native individuals seek mental health services at very low rates. Indeed, only 11% to 13% of American Indians and Alaska Natives have sought professional help (Novins et al., 2004), suggesting that many Alaska Native individuals have unmet mental health needs. A Shift in Approach: Appreciating Alaska Native Elders The common reasons for the lack of The common reasons for …low rates of effectiveness of existing efforts, and the service utilization among Alaska Native low rates of service utilization among peoples, are the services' lack of cultural Alaska Native peoples, are the services' sensitivity and deficit-based approach. …One way to incorporate Alaska Native lack of cultural sensitivity and strength and culture into our efforts is to deficit-based approach. A shift toward collaborate with Alaska Native elders. incorporating Alaska Native strength and culture into our conceptualization of and interventions for the issues they face may improve our understanding of their experiences and the effectiveness of our services. -XXIV-

One way to incorporate Alaska Native strength and culture into our efforts is to collaborate with Alaska Native elders. Generativity is a cultural value among Alaska Natives, and the idea of leading and caring for the next generation impacts elders' sense of purpose. For elders, having a role in one's community and being involved in decision-making are keys to successful aging (Lewis, 2009). Resilience-based approaches are effective alternatives for improving health (Saylor, Graves, & Cochran, 2006). Alaska Native elders are examples of resilient individuals who have experienced historical and contemporary oppression, who have taken control of their well-being, and who may serve as role models for the younger generations. Elders are also culture bearers who are often the source of guidance in Alaska Native communities. Thus, efforts can be guided by elders to ensure that cultural values and ways of knowing are Ruth Zuniga, M A considered. In this sense, Alaska Native elders may be instrumental in broadening our understanding of success to also include culturally-valued skills such as beading and hunting, instead of western-based indicators such as school grades and drop-outs. Such cultural skills may also serve as protective factors against other behavioral concerns among youth such as substance use, unprotected sex, and many others. Alaska Native elders also view life with optimism, a cultural value that maintains a positive outlook regardless of difficulties (Lewis, 2009) which possibly makes Alaska Native elders healthier than their counterparts from other ethnic groups. For instance, suicide among Alaska Natives over 55 years-old is low to nonexistent. In contrast, individuals over 55 in the general population have the highest suicide rates among all age groups (Sullivan & Brems, 1997). Thus, there is plenty to learn from elders regarding the problem of depression and suicide. E. J. R. David, PhD

Many elders also continue to use herbs and circles (Lewis, 2009), and thus, can also be instrumental in integrating Western and traditional healing. This is one manner in which services can become more culturally-sensitive, and one way in which service utilization rates can be improved. Finally, given that alcoholism is considered as the most concerning issue among Alaska Native communities, it is often overlooked that this

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population also has the highest rate of alcohol abstinence in the country, and many who abstain from alcohol are elders. Thus, there is plenty to learn from elders as well in terms of identifying factors that facilitate sobriety. Conclusion As more efforts take into consideration the As more efforts take into consideration the words, stories, and knowledge of Alaska words, stories, and knowledge of Alaska Native elders, there will continue to be a Native elders, there will continue to be a shift towards a strengths- based and shift towards a strengths-based and culturally-appropriate approach to health. culturally-appropriate approach to health. …This shift…and the realization that elders What is perhaps the best example of how are the sources, models, and bearers of successful an elder-guided, strength and culture - are needed in order strength-based, and culturally-appropriate to improve the effectiveness of our effort can be is the People Awakening services. Project (Mohatt et al, 2004), showing that change is already beginning to take place. This shift toward incorporating the strength and culture of Alaska's indigenous groups - and the realization that elders are the sources, models, and bearers of strength and culture - are needed in order to improve the effectiveness of our services. References Alaska Behavioral Health Survey (2002). Health Risks in Alaska Among Adults: 1999 Annual Report. Alaska Department of Health and Human Services. Alaska Department of Health and Social Services. (2007). Alaska Health Care Data Book: Selected measurements 2007. Retrieved from http://www.hss.state.ak.us/dhcs/healthplanning/publications/healthcare/default.htm#download on May 20, 2010. Boraas A. S. (1991). Peter Kalifornsky: A Biography. In J. Kari, & A. S. Boraas (Eds.), A Dena'ina Legacy - K'tl'egh'i Sukdu: The Collected Writings of Peter Kalifornsky. Fairbanks, AK: Alaska Native Language Center, University of Alaska Fairbanks. Division of Alcoholism and Drug Abuse (1999). A summary of recent findings regarding substance abuse in Alaska. Juneau, AK: Department of Health and Social Services Lewis, J. (2009). Successful aging through the eyes of Alaska Native Elders. What it means to be an Elder in Bristol Bay, AK. Published dissertation. Mohatt, G. V., Hazel, K. L., Allen, J., Stachelrodt, M., Hensel, C., & Fath, R. (2004). Unheard Alaska: Culturally anchored participatory action research on sobriety with Alaska Natives. American Journal of Community Psychology, 33, 263-273. Morgan, R. & Freeman, L. (2009). The Healing of Our People: Substance Abuse and Historical Trauma. Substance Use & Misuse, 44:84-98 -XXVI-

Napoleon, H. (1996). Yuuyaraq: The way of the Human Being. Alaska Native Knowledge Network: Fairbanks, AK. Novins, D. K., Beals, J., Moore, L. A., Spicer, P., Manson, S. M., & AI-SUPERPFP Team (2004). Use of biomedical services and traditional healing options among American Indians: Sociodemographic correlates, spirituality, and ethnic identity. Medical Care, 42, 670-679. Roderick, L. (2008). Do Alaska Native people get free medical care? Anchorage, AK: University of Alaska Anchorage and Alaska Pacific University. Saylor, B., Graves, K., & Cochran, P. (Spring/Summer 2006). A Resilience-Based Approach to Improving Community Health. Northwest Public Health. Sullivan, A. & Brems, C. (1997). The Psychological Repercussions Of The Sociocultural Oppression Of Alaska Native Peoples. Genetic, Social, and General Psychology Monographs, 123, 4, 411-440. E. J. R. David, PhD was born and raised in the Philippines and moved to Alaska when he was 14 years-old. He obtained his Bachelor's Degree in Psychology from the University of Alaska Anchorage, his Master's Degree in Psychology from the University of Illinois at Urbana-Champaign, and his Ph.D. in Clinical-Community Psychology at the University of Illinois at Urbana-Champaign. He is currently an assistant professor of psychology at the University of Alaska Joint PhD Program in Clinical-Community Psychology, where he conducts research on the psychological impacts of colonialism and oppression. Jordan Lewis, PhD was an Assistant Professor with the Department of Alaska Native Studies and Rural Development at the University of Alaska Fairbanks where he also received his doctoral degree in Cross-Cultural Community Psychology in December 2009. Dr. Lewis did his research with Alaska Native elders in the Bristol Bay region to establish an Alaska Native definition of successful aging. His research interests include indigenous gerontology, Alaska Native and rural community health, circumpolar health, and indigenous community sustainability. Tina Marie Woods, MS is Unungan (Aleut) from St. Paul Island, Alaska. She obtained a Bachelor's and a Master's Degree in Psychology from the University of Alaska Anchorage, and she is currently a doctoral candidate in the University of Alaska Anchorage & University of Alaska Fairbanks Joint Ph.D. Program in Clinical-Community Psychology with a Rural Indigenous Emphasis. Her research interests focus on utilizing the "talking circle" as a traditional method for healing historical trauma. Ruth Zuniga, MA was born and raised in Costa Rica. She obtained a Bachelor's degree in psychology from the Universidad Latina de Costa Rica and a Master's degree in Counseling and Human Services from the University of Idaho, and is currently a doctoral candidate in the University of Alaska Anchorage & University of Alaska Fairbanks Joint Ph.D. Program in Clinical-Community Psychology with a Rural Indigenous Emphasis. Her primary research interests include mental health of immigrants and experiences of Hispanic women in counseling and other therapeutic services.

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Indigenous Healing en La Comunidad Latina Brian W. McNeill, PhD Washington State University Cultural Roots of Latino Healers

Brian W. McNeill, PhD

Walking down the calle (street) in Havana, Cuba, you encounter a modest residence and are directed to a private room filled with sacred objects and symbols, some of which appear to resemble various catholic saints. You are then introduced to Orlando, the healer or Santero who asks you to describe what is bothering you and listens attentively as you describe your situation in an attempt to understand. The Santero asks you about your relationships with friends and family, and perhaps your personal or work history. At the end of the consultation or registo, you are given a "homework" assignment to visit the shrine of San Lazaro. You then leave a monetary offering. Your visit to the shrine precipitates reflection upon your life circumstances, which results in feelings of relief and calmness.

Such encounters with practitioners of La Religión (The Religion) known as Santería occur not only on a daily basis in the barrios (neighborhoods) of Cuba, but also in Cuban-American communities in the United States. Similar spiritual healing traditions exist for the variety of Latina/o American peoples in the form of Curanderismo for Mexican-Americans or Espiritismo for Puerto Ricans. While such practices often serve as a complement to conventional psychological treatment, in many cases the Santero/a, Espiritista/o, or Curandero/a is the primary healer one turns to in cases of both physical and/or psychological illness, especially when one lacks monetary resources, health insurance, or when previous conventional treatments have been ineffective. These healers may possess any number of special areas of expertise, and are often knowledgeable in the use of herbal remedies for emotional problems or particular cultural syndromes. Latina/os are mestizo (mixed) peoples both culturally and genetically as they represent an amalgamation of influences, practices and worldviews. For example, Santería is an Afro-Cuban mix of magic rites of the Yoruba and the traditions of the Catholic Church in which the catholic saints have been syncretized with deities known as Orishas (McNeill, Esquivel, Carrasco, & Mendoza, 2008). Espiritismo combines pre-Columbian, African, Catholic, and European spiritual/religious practices to fulfill the spiritual and psychocultural -XXVIII-

needs of Puerto Rican people (Torres-Rivera, 2005). Similarly, Curanderismo reflects the mutual influence of the Spanish/Iberian and Native/Nahuatl cultures in the Americas (Ortiz, Davis, & McNeill, 2008). All of these traditions represent holistic systems of healing that addresses communal, physical, and psychological, as well as spiritual aspects in treatment. However, it is the spiritual/religious aspects that are not well understood by conventional mental health practitioners. Underlying Worldviews Many segments of the Latina/o population hold a worldview that includes beliefs that illness and health are strongly influenced by spiritual and religious factors that may ultimately affect therapeutic outcomes. These include the belief that religion and spirituality permeate human experience, as

Many segments of the Latina/o population hold a worldview that includes beliefs that illness and health are strongly influenced by spiritual and religious factors that may ultimately affect therapeutic outcomes.

an individual's life is a spiritual phenomenon, where humans, animals, Many of these beliefs are part of complex plants, and the natural world are medicine systems that originated in interrelated, with God being the driving pre-Columbian times and continue to be force. Many of these beliefs are part of represented in the mestiza/o worldviews complex medicine systems that originated of Latina/as (Ortiz et al., 2004). in pre-Columbian times and continue to be represented in the mestiza/o worldviews of Latina/as (Ortiz et al., 2004). Thus, it is vitally important that mental health professionals who wish to be effective in their work with Latina/os attempt to become familiar with these worldviews in order to understand, treat, and communicate with Latina/os. Practices consistent with the mestiza/o worldview may include the seeking of a traditional healer who is known in one's barrio, or through a visit to a Botánica or store that sells spiritual and religious products where a healer may practice. Interventions may take the form of the previously mentioned registo, herbal remedies, limpias (ritual cleansings), and communication with the supernatural through prayer or mediumship, as well as other healing rituals. Universal Healing Principles Why is the traditional healer often effective? For decades, Jerome Frank (e.g., Frank & Frank, 1991) has argued that all healing practices share (a) an emotionally charged, confiding relationship with a healer; (b) a healing context in which the therapist has the power and -XXIX-

expertise to help and a socially sanctioned role to provide services; (c) a rationale or conceptual schema to explain problems, and (d) a ritual or procedure consistent with the treatment rationale. Fisher, Jome, and Atkinson (1998) provide evidence for what they term "universal healing conditions" in a culturally specific context, which includes the therapeutic relationship, a shared worldview, client expectations, and a ritual or intervention. Recent research in factors responsible for psychotherapy effectiveness by Wampold (2001a, 2001b) supports the view that all healing traditions share common healing factors responsible for effectiveness. Wampold also presents a strong case for the lack of evidence supporting the medical model of psychotherapy where specific therapeutic treatments or "ingredients" (e.g., empirically supported treatments) are assumed to be primarily responsible for the effectiveness of psychotherapy. Perhaps for these reasons, traditional healing practices continue to survive and serve vital functions for Latina/o communities. The work of these researchers has recently had an influence on conventional mental health policy in the form of the 2006 report of the APA Presidential Task Force on Evidence-Based Practice (EBPP) defined as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" (APA, 2006, p.273). EBPP also "involves consideration of the client's values, religious beliefs, world views, goals and preferences for treatment with the psychologist's experiences and understanding of the available research" (APA, 2006, p. 278). Conclusion Thus, within this context, it is crucial for practitioners to be open and accepting of a mestizo/a worldview which incorporates traditions with which practitioners may be unfamiliar. Healing traditions such as Curanderismo, Santería, and Espiritismo are experiencing a resurgence in Latina/o communities as they provide strength, resilience, and comfort during difficult times and life transitions. It is gratifying that organized Psychology is beginning to acknowledge these traditions. As the practitioners of Santería say "hay muchos caminos" (there are many ways). References American Psychological Association (2005). Evidence-based practice in psychology. American Psychologist, 61, 271-285. Fischer, A. R., Jome, L. M., & Atkinson, D. R. (1998). Reconceptualizing multicultural counseling: Universal healing conditions in a culturally specific context. Journal of Counseling Psychology, 26, 525-588. Frank, J. D. & Frank, J. B. (1991). Persuasion and Healing: A Comparative Study of Psychotherapy (3rd). Baltimore, MD: Johns Hopkins University Press.

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McNeill, B. W., Esquivel, E., Carrasco, A. & Mendoza, R. (2008). Santería and the healing process in Cuba and the United States. In B. W. McNeill & J. M. Cervantes (Eds.). Latina/o healing traditions: Mestizo and Indigenous perspectives. New York: Routledge. Ortiz, F. A., Davis, K. G., & McNeill, B. (2008). Curanderismo: Religious and spiritual worldviews and indigenous healing traditions. In B. W. McNeill & J. M. Cervantes (Eds.). Latina/o healing traditions: Mestizo and Indigenous perspectives. New York: Routledge. Torres Rivera, E. (2005). Espiritismo: The flywheel of the Puerto Rican spiritual traditions. Interamerican Journal of Psychology, 39, 295-300. Wampold, B. E. (2001a). Contextualizing psychotherapy as a healing practice: Culture, history, and methods. Applied & Preventive Psychology, 10, 69-86. Wampold, B. E. (2001b). The great psychotherapy debate: Models, methods, and findings. Mahwah, New Jersey: Lawrence Erlbaum Associates. Brian W. McNeill, PhD is a professor and director of training for the Counseling Psychology Program at Washington State University. He is the co-editor of The Handbook of Chicana and Chicano Psychology and Mental Health, and is a licensed Psychologist in the states of Washington and Idaho where he practices and consults.

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Contextual Understanding of Two-Spirit Peoplehood Mark Standing Eagle Baez, MA, CSP, LCDC Native American and First Nation (Canada) gay and bisexual people are a misunderstood and misrepresented group. This paper is a basic overview and a historical look at Native American and First Nation communities and their embracing of the "Two-Spirit" personhood. According to Sabine Lang, author of "Man In tribal societies, modern Native as Women, Women as Men," the American gays and lesbians regard the terminology of "Two-Spirit" originated in combination of masculine and feminine 1989 during an international/intertribal potentials as a more abstract, "spiritual" quality inherent, or inborn, in gathering of gay and lesbian Native homosexuals. Americans. Native American lesbians and gays have long been struggling to find an identity and to develop self- identifying terms appropriate to them. Although we understand there is increased acceptance of "Two-Spirit" societies, hate crimes continue to persist. They seek terms reflecting both their sexual orientation and their specific ethnic heritage. In tribal societies, modern Native American gays and lesbians regard the combination of masculine and feminine potentials as a more abstract, "spiritual" quality inherent, or inborn, in homosexuals (Lang, 1998). A Historical View of Two-Spirit in Native America An extensive study of the "berdache" culture among Native Americans was conducted by Walter L. Williams (1986, 1992). In Williams' research, he describes the "berdache" as practice, social roles, and history, and also as an understanding of belief in sin and prejudice of sexual diversity from Europeans. Will Roscoe (1998), author of Changing Ones: Third and Fourth Genders in Native North America, said that upon arriving in the New World, explorers learned of cultures that did not adhere to the same social mores. Roscoe goes on to say that the notion Mark Standing Eagle Baez, MA, of three, four, or even an infinite amount of gender CSP, LCDC categories was the norm (1998). Roscoe also points out that men who lived as women, or "Two-Spirit Men," were not necessarily ostracized by their societies. In fact, some of these "Two-Spirit Men" were regarded as spiritual leaders (Roscoe, 1998; Williams, 1992; Lang, 1998). Williams (1986, 1992), states that many tribes see the berdache's role as signifying an individual's gifts as a -XXXII-

dreamer and a visionary. For example, among the Papagos, these qualities are accepted as a compelling gift for the supernatural world (Williams, 1986,1992). Dr. Wesley Thomas, a professor at Dine' College and co-author of "Two-Spirited People," and expert on the subject of the Navajo nádleehí tradition, describes the five genders recognized by the Navajo. The first is the feminine woman ('asdzaan). The second is the masculine man (hastiin). The third is the male-bodied person who has a feminine essence (nádleeh). The fourth is the female-bodied person who has a masculine essence (nadleeh). The fifth is the androgynous/hermaphrodite (nadleeh) (Jacobs, Thomas and Lang, 1997). Most tribes were aware of the persistence of "Two-Spirit" people, and many still have a name in their traditional language. For example, the Dine' (Navajo) referred to two spirited people as nádleehí , the Lakota (Sioux) as winkte, the Mohave as alyha, the Zuni as lhamana, the Omaha as mexoga, the Aleut and Kodiak as achnucek, the Zapotec as ira' muxe, the Cheyenne as he man eh, and the Hopi as Ho va (Roscoe, 1988a). The Lakota, according to Williams (1986, 1992) believe that the white buffalo calf is a "berdache." The Lakota word winkte is composed of win "women," and kte, would become. One way one may become a winkte is to be put on the hill by a medicine man for a vision or to have a vision given by a winkte from the past (Williams, 1986, 1992). Today's Two Spirit in Native American Communities Today's societal standards look down on feminine males and this prejudice has found its way into Native society. Thomas states that much of the western world has adopted the term "berdache" to describe the "Two-Spirit," however this is actually considered offensive by traditional Native Americans. "Berdache" was a term coined by the French for "Two-Spirit" members of tribe. It meant "kept boy; male prostitute, catamite," from the Arabic bardaj. (Jacobs, Thomas & Lang, 1997). Adam Armstrong is a member of the "Two-Spirited" people often feel Northeast Two-Spirit Society and works something else, something more than professionally in a healing capacity as a merely to whom we are sexually attracted: a strong and inherent connection to either New York City Fire Department Paramedic feminine or masculine energies, with and Hazardous Materials Technician. He some feeling a balance of both energies. states that today, "many Two-Spirited people begin their journey by identifying as lesbian, gay, bisexual, or as intersex/transgendered" (Armstrong, 2007). He goes on to say that "Two-Spirited" people often feel something else, something more than merely to whom we are sexually attracted: a strong and inherent connection to either feminine or masculine energies, with some feeling -XXXIII-

a balance of both energies (Armstrong, 2007). Today there are many "Two-Spirited" societies throughout the United States and in Canada. According to Gilley (2006), the use of the The "Two-Spirit" have been with us for term "Two-Spirit" has increased in centuries and accepted in Native popularity, thus making more people to communities. However, the Western idea feel connected to their indigenous tradition has imposed the identity of "Two-Spirit" (Gilley, 2006, p. 30). There has been as deviant and has harmed many Native kids. movement by Native people to reclaim the term "Two-Spirit" as a cultural identity separate from the White mainstream gay and lesbian society. Although we understand there is increased acceptance of "Two-Spirit" societies, hate crimes continue to persist. As a Native practitioner, I support the idea that the "Two-Spirit" have been with us for centuries and accepted in Native communities. However, the Western idea has imposed the identity of "Two-Spirit" as deviant and has harmed many Native kids. References Armstrong, A. (2007, Spring Issue 2 volume 1). Two-Spirit Today. Drawing from the past, living in the present, p. 2. Gilley, B. (2006). Becoming Two-Spirit: Gay Identity and Social Acceptance in Indian Country. Lincoln: University of Nebraska Press. Jacobs, S. E., Thomas, W., & Lang, S. (1997). Introduction. Two-Spirit People: Native American Gender Identity, Sexuality and Spirituality, 1-18. Lang, S. (1998). Men as Women, Women as Men. Austin: University of Texas Press. Roscoe, W. (1998). Changing Ones: Third and fourth genders in Native North America. New York: St. Martin's Press. Roscoe, W. (Ed.). (1988). North American Tribes with Berdache and Alternative Gender Roles. Living The Spirit: A Gay American Anthology, 217-222. Roscoe, W. (1991). The Zuni Man Woman. Albuquerque: University of New Mexico Press. Williams, L. W. (1986, 1992). The Spirit and the Flesh: Sexual diversity in American Indian culture. Massachusetts: Beacon Press. Mark Standing Eagle Baez, MA, CSP, LCDC, CART is of Mohawk/Pawnee/Coahuiltecan/ Mexican descent. He received his BA from Our lady of the Lake University in San Antonio and his Masters (Psychology) from North Central University in Prescott AZ. He also holds a second Masters as a School Psychologist. He has provided numerous presentations and trainings that make use of traditional Native American culture and beliefs and highlight the importance of effective stress management and a well-balanced spiritual life for developing health and wellness in personal and community life.

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GUIDANCE FOR CLINICAL PRACTICE

Pivotal Protocols: The Spirit Dimension in Indigenous and Western Psychologies Suzan McVicker, MA, LPC Madison, Wisconsin Variants of these conditions [spirit possession states] have been described in nearly every traditional society on every continent. ("Dissociative Trance Disorder" listed in Appendix B, Criteria Sets and Axes Provided for Further Study, DSM-IV-TR, pp. 783-785). It [spirit possession states] shifts the question from "How is it that other peoples believe the self [person] to be permeable by forces from without?" to "How is it that Western models have repeatedly denied such permeability? "(Boddy 1994, p. 427). The Best of Both Worlds Side-by-Side As the American Indian "patient" explores Accustomed for centuries to traveling the meaning of well-being in the 21st back and forth between cultures, Century, providers involved are offered a American Indians increasingly see parallel opportunity. Indigenous peoples are concurrent dual treatment protocols as a means to find relief from the currently telling researchers how they accumulating sufferings resulting from envision attaining well-being. Accustomed the devastations in history and for centuries to traveling back and forth acculturation. between cultures, American Indians increasingly see concurrent dual treatment protocols as a means to find relief from the accumulating sufferings resulting from the devastations in history and acculturation. As trust is rebuilt between practitioner groups with two epistemologies, American Indian healers and Western psychologists, best practices may occur side-by-side. Culturally-derived tandem approaches may heighten understandings of well-being in each worldview better than highly collaborative climates. When one culture fosters consciousness of its own identity's strengths and limitations, a compassionate Wel l-being in most Indi genous embrace of a different culture becomes communities includes the overlapping possible. relationship between humans and forces in the spirit world. Generally, this blending of dimensions respects a permeable boundary which organizes the seen, physical human world on one side and the unseen spirits on the other.

W ell-being in m ost Indigenous communities includes the overlapping relationship between humans and forces in the spirit world. Generally, this blending of

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dimensions respects a permeable boundary which organizes the seen, physical human world on one side and the unseen spirits on the other. In many Indigenous cultures it is also a normal interface for a spirit force to manifest itself in a human body. Here, in the mingling point of the unseen with the seen, is an elegant coherence between long-held Indigenous cosmology and new Western sciences. The logical mind is capable of grasping some of the mysteries embedded in contemporary explorations of non-linear time; cause and effect relationships based on universal connectedness of all existence; and the power of consciousness to impact non-local physical reality (Braden 2008, Emoto 2004, Parry 2006). How, then, does this mingling of dimensions inform culturally-derived approaches for American Indians who want concurrent healing modalities from their own traditions and Western psychology? Prior to the current era for Western psychology, one of the biggest gaps a Western trained psychologist had to leap was into the American Indian everyday experience which seamlessly includes a spirit dimension. Notions of isolating, measuring, and manipulating discreet parts of reality believed to be separate, inert, and non-impacting on other areas of reality Suzan McVicker, MA, LPC hampered the jump. Today, providers working side-by-side using different protocols with no expectation to dominate or convert may enjoy a natural outgrowth of research investigations and sharing of best practices which emerge in the interest of their patients. Consciously sharing the whole universe in mysterious movement with all living beings in an interactive, fluidly interconnected relationship is quickly becoming common ground for informing best practices in both Indigenous and Western psychologies. Patients who live in Indian Country and the U.S., citizens of nations within a nation, might feel supported by providers who authentically consider reality to be both manifest and unmanifest. A Center from Which to View the Whole The root metaphor of the circle contains valuable perspectives for viewing, naming, and exploring effective practices for restoring well-being after generations of trauma transmission. Each part of the circumference of a circle is a point of information connected with the center, a central viewpoint. The available intelligence in this intersection of central location carries the potential for an equal influence with the perspective from each unique part. Useful for organization of the whole in a visible, physical community or circle, this metaphorical center also serves as a pivotal point for turning inward to understand psychological and spiritual unseen reality. Passed down from many empowering Indigenous sacred languages are terms which describe the human center: This profound, universal -XXXVI-

essence is translated as sacred space, heart, zero point, self, no-self, the void, source, within direction, and more. Deeply held across American Indian cultures is the belief that all living beings possess a center essence which is in connection with the center essence of each human. Transgenerational spirit or soul wounding is increasingly understood to cascade the poison of its impacts down the descending familial, kinship, and community line into measurable maladies like addictions, anxiety, depression, and violence. Genuine interactive familiarity with the impacts of the unseen dimensions on the visible, measurable world leads to fruitful dialogue about best practices for the treatment of historical trauma. The center-to-center connections inherent in all forms of the natural world and all manifestations of the inner world have been described by Indigenous and Western scholars in terms which link all domains with the Center of the Cosmos in a universal dimension. Confronted with such a worldview of time-free enmeshment of all dimensions, Western psychology is drawn to new perspectives. If inner forces are interactive with external life and the Heart of the universal Cosmos simultaneously, the possibilities for understanding spirit or soul wounding in a context of historical trauma open further. Spirit possession, described in the DSM-IV-TR as a ubiquitous tenet of Indigenous cultures, is less a leap and more a natural step into understanding American Indian well-being. Transgenerational spirit or soul wounding is increasingly understood to cascade the poison of its impacts down the descending familial, kinship, and community line into measurable maladies like addictions, anxiety, depression, and violence. Genuine interactive familiarity with the impacts of the unseen dimensions on the visible, measurable world leads to fruitful dialogue about best practices for the treatment of historical trauma.

The circle metaphor can be helpful again for deepening the concept that nothing is outside of core human essence. Spirit possession is a state of consciousness which is altered by the replacement of a customary sense of personal identity by another identity. This new identity is attributed to the influence of a spirit, power, deity, or other person who overpowers the self of the host person.1/ The invasive spirit at times takes over in order to get something which a human can obtain: alcohol, revenge, or the familiarity of returning to an earthbound environment, for example. Based on a permeable construct of self (heart, center, source, essence, or within direction), spirit depossession is the practice of conducting the overpowering spirit safely back to its place of origin. This departure liberates the patient. Unlike the specters of forceful banishment raised by the term "exorcism", spirit depossession

1/

Many cultures make room for alliances between human beings and spirit beings which are consensual and positive within permeable boundaries.

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accomplished with skill and compassion does not induce increased trauma, but rather, results in the reclamation of separate boundaries for both the conscious human host and the possessing spirit. Both, in a real external and internal sense, are patients. Reestablishment of separate boundaries for each restores personal identities and holistic balance for the host and the formerly possessing spirit. Depossession, then, may be conceptualized as one form of unburdening, clearing, or transmuting the overpowering spirit. By understanding human core essence through the root metaphor of the center, Indigenous and Western psychologies may find a continuum of approaches for effective tandem work. When the overlaps of the human world and forces of the spirit are considered to be normal occurrences, American Indians may enter into psychotherapy feeling more assured of being understood, respected, and knowledgeably treated. For example, in a routine case of unwanted spirit possession, it is important to authentically grasp the context of a cosmos without borders. If presenting indicators are mistaken for a serious psychiatric disorder, the patient could suffer intensely with incorrect treatment while proper care for spirit depossession would not be considered. The Center Sets the Field for Pivotal Protocols Qualities of the center, heart, or self set the As researchers link brain states with field for psychotherapeutic protocols which well-being, patterns appear which affirm are finding effectiveness in treating ancient knowing: Inner states of historical trauma and its transgenerational compassion, calm, and clear, settled impacts. As researchers link brain states ability to witness all which exists in the mind and deep in the within direction with well-being, patterns appear which have a healing effect, in turn, on body, affirm ancient knowing: Inner states of mind, spirit, and energy. compassion, calm, and clear, settled ability to witness all which exists in the mind and deep in the within direction have a healing effect, in turn, on body, mind, spirit, and energy. Across traditional Indigenous cultures is agreement that healing arises from the inside. Wisdom and teachings to access centered states are once again emerging to be shared after the recent centuries when American Indian healing practices were actually prohibited by U.S. law. In particular, the teachable skills that open the doors to a centered state are described in the vocabulary of psychotherapy protocols. Therapeutic trance states, mindfulness meditation, and schools teaching awareness for inner dialogue have brought terms such as "going inside" and "inner parts" into common parlance. Jung, the seminal scholar and practitioner whose body of work influenced the models of both Schwartz (1995, 2001) and Duran & Duran (1995), embraced the spirit dimension in psychology. Schwartz' Internal Family Systems -XXXVIII-

(IFS) model trains practitioners in holding an energy field of centeredness with a specific language for exploring the within direction. In case studies describing his "hybrid" Post-Colonial Psychology which fuses Indigenous and Western bases, Duran & Duran use language to directly address the spirits that upset the harmony and balance of well-being. "Direct access", a term to describe vocalizing a spirit's communication through the voice of the patient, has since ancient times been a way of communicating across the porous boundary between humans and spirits. Both Indigenous and Western psychologies are vast, complex systems which provide treatments to maintain well-being. The language, skills, and worldview inherent for practitioners who support spirit depossession in their work naturally cultivate strong abilities to communicate with those who are different. Beginning treatment protocols by setting the energy field with an invitation for centering, for example, is an implicit understanding of sacred space. Welcoming Indigenous language is an empowering support for transcending theoretical conflicts. Differentiating the human patient from the spirit force; tracking the spirit's progress as it makes its way "home"; continuing care after re-establishing harmonious boundaries; supporting cognitive and behavioral pattern change once the spirit influence is cleared: Practitioners carrying these skills increase their capacity to serve American Indian populations who are at risk from the exponentially multiplying wounds of historical trauma. References Alegria, M. & McGuire, T. (2003). Rethinking a universal framework in the psychiatric symptom-disorder relationship. Journal of Health and Social Behavior, 44 (Sept.) 257-274. American Psychiatric Association, (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association. Braden, G. (2008). The Spontaneous Healing of Belief: Shattering the Paradigm of False Limits. Carlsbad: Hay House. Boddy, J. (1994). Spirit possession revisited: beyond instrumentality. Annual Review of Anthropology (24) 407-434. Buchwald, D., Beals, J., & Manson, S.M. (2000). Use of traditional health practices among Native Americans in a primary care setting. Medical Care, 38 (12) 1191-1199. Corbett, S. (2009, September 16). The holy grail of the unconscious. The New York Times. Retrieved from http://www.nytimes.com. Christiansen, M. (n.d.). Diagnostic criteria in clinical settings: DSM-IV and cultural competence. American Indian and Alaska Mental Health Research: The Journal of the National Center. Duran, E. & Duran, B. (1995). Native American Postcolonial Psychology. Albany State University of New York Press. Duran, E. (2006). Healing the Soul Wound: Counseling with American Indians and Other Native Peoples. New York: Teachers College Press of Columbia University. Emoto, M. (2004). The Hidden Messages in Water. Hillsboro: Beyond Words Publishing.

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Garrett. J. T. (2001). Meditations with the Cherokee: Prayers, Songs, and Stories of Healing and Harmony. Rochester: Bear & Company. Goodman, L. (2010). Between two worlds: Malidoma Soma on rites of passage. The Sun, 415/July 2010, 4-11. James, J. (2009). The sacred feminine in Cherokee culture: healing and identity. L. J. Lefler (Ed.), Under the Rattlesnake: Cherokee Health and Resiliency. (pp. 102-124). McCabe, G. H. (2007). The healing path: A culture and community-derived indigenous therapy model. Psychotherapy: Theory, Research, Practice, Training, 44 (2) 148-160. Parry, G. A. (2006). Native wisdom in a quantum world. Shift: At the Frontiers of Consciousness, (9) Dec/Feb 2006. Petri, H. (2003). Dances of Ecstacy. Luna Pictures Production. Rabasca, L. (2000). Listening instead of preaching. Monitor on Psychology, 31 (3). Reifel, N. (2001). American Indian views of public-health nursing, 1930-1950, In C.E. Trafzer & D. Weiner (Eds.), Medicine Ways: Disease, Health, and Survival among Native Americans (pp. 95-107). Rhoades, E. R. & Rhoades, D.A. (2000). Traditional Indian and modern western medicine. In E. R. Rhoades (Ed.), American Indian Health: Innovations in Health Care, Promotion, and Policy (pp. 401-417). Baltimore: The Johns Hopkins University Press. Sams, J. (1998). Dancing the Dream: The Seven Sacred Paths of Human Transformation. New York: Harper Collins. Schwartz, R. (2004). The larger self. Psychotherapy Networker, May/June 2004. Schwartz, R .C. (1995). Internal Family Systems Therapy. New York: The Guilford Press. Schwartz, R. C. (2001). Introduction to the Internal Family Systems Model. Oak Park: Trailheads Publications. Weithaus, U. (2008). Foundations of First Peoples' Sovereignty: History, Education & Culture. New York: Peter Lang. Suzan A. M. McVicker, MA, LPC is in private practice as a psychotherapist in Madison, Wisconsin. She recently completed the new Culturally-Based Native Health Program offered by the Eastern Band of Cherokee Indians and Western Carolina University; is earning a PhD in Human and Organizational Development at Fielding Graduate University; and continues to learn experientially with Indigenous healers. She is a Cherokee descendant.

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Cultural Health Beliefs and Conceptualization of Illnesses Among Haitians Guerda Nicolas, PhD María José Rendón University of Miami It is well documented that the integration of indigenous cultural beliefs in the treatment of migrant and ethnic minority groups is not only important but necessary (Bernal, Jiménez-Chafey & Domenech Rodríguez, 2009). Indeed, cultural notions of health and illness progression have been noted to influence people's health behaviors and treatment choice (Pan American Health Organization, 2007). However, mental health care in the United States still falls short from integrating indigenous notions of health and mental health progression and treatment.

Guerda Nicolas, PhD

This paper provides a brief overview of the indigenous health model for a particular cultural group, Haitians. Along with this overview, we propose strategies that practitioners can use to incorporate their clients' health beliefs model, as well as the participation of family and community partners into the treatment. As culturally-sensitive care for Haitians involves a much broader knowledge of the etiology and manifestation of mental health illnesses within this group, we refer readers to the work of Nicolas and colleagues (Nicolas, Schwartz & Pierre, 2010; Nicolas, DeSilva, Beltrame, 2009; Nicolas, DeSilva, Prater & Bronkoski, 2009; Nicolas et al., 2007; Nicolas, DeSilva, Grey & Gonzalez-Eastep, 2006) which present more in-depth information on this topic. Conceptualization of Health, Illness and Treatment Among Haitians Among Haitians, "good health" is constructed as being able to maintain a good internal equilibrium between cho (hot) and fret (cold), being strong and plump, having good color, and in general, being free from pain. This state of well-being is moreover, acquired through good diet, hygiene,

Among Haitians, "good health" is constructed as being able to maintain a good internal equilibrium between cho (hot) and fret (cold), being strong and plump, having good color, and in general, being free from pain. …Illnesses may come about due to the disruption of good habits…but may also be attributed to unnatural courses of illness, such as a curse.

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sleeping habits, physical activity, and spiritual practices (Colin & Paperwalla, 1996; Kirkpatric & Cobb, 1990; Laguerre, 1984; Miller, 2000, in Nicolas, Hirsh & Beltrame, 2009). Illnesses may come about due to the disruption of good habits, as described above, but may also be attributed to unnatural courses of illness, such as a curse.

María José Rendón

When people get sick (either mentally or physically), illness progression is tracked across four stages. An illness often begins with the person reporting Kom pa bon ("I do not feel well"), a stage with mild, rather than severe symptoms. The next stage is characterized by a decrease in activity, confinement to home and the patient reporting moin malad ("I am sick"). In the next stage, severe symptoms are accompanied by confinement to bed, and a report of moin malad anpil ("I am very sick"). The final stage is accompanied by hopelessness about ever getting better, in which the person reports moin pap refe ("I am dying") (Angel & Guarnaccia, 1989; in Nicolas, Hirsh & Beltrame, 2009).

The treatment of illnesses among Haitians is very much linked to spiritual and folk medicine practices such as consulting with a leaf doctor that may provide the appropriate herbs for the specific symptoms suffered. Cultural healing rituals with a Hougan or Mambo (Voodoo priest or priestess, respectively) are also regarded as necessary when the illness is attributed to a curse. Within Haitian communities in the U.S., healers are certainly accessible and sometimes collaborate with medical doctors to provide clients with the best care possible (Prince, 2005, in Nicolas, Hirsh & Beltrame, 2009). Working with the Haitian Client For Haitians, the idea of seeing a For Haitians, the idea of seeing a psychologist is rather extraordinary, if not psychologist is rather extraordinary, if not stigmatized, as is the case in many other stigmatized,…When (and if) a Haitian cultural minority groups. Moreover, patient arrives at a clinician's office, it is only after attempts at recovery through Haitians often experience stress as physical, other resources in the lakou (extended rather than mental, which may further delay family), church, Voodoo and folk their search for psychological services (cf. medicine, have failed. Nicolas et al., 2007). When (and if) a Haitian patient arrives at a clinician's office, it is only after attempts at recovery through other resources in the lakou (extended family), church, Voodoo and folk medicine, -XLII-

have failed. Recognizing the journey that these patients have traveled to get to us is hence necessary to build a strong foundation to the therapeutic relationship. As discussed above, developing a culturally-congruent treatment necessitates an integration of indigenous health beliefs. Though ways to engage the client into this conversation may vary, we offer some strategies to facilitate dialogue: 1.

Health beliefs may be inquired through questions such as "How do you think these symptoms came about?", "What meaning do you make of them?" and "Why do you think that these things are happening to you now?"

2.

Sense of illness progression and severity may be inquired through questions such as "How does the symptom feel like?", "When and where in the body does it start? When and where does it feel stronger? and How long does it last, when it comes?"

3.

Client's beliefs surrounding appropriate treatment may be a more sensitive subject to discuss. As previously stated, being familiar with the role of folk medicine and spiritualism in the cultural group of the client can facilitate the sense of safety clients need to explicate their story. Questions such as "What actions have you taken to relieve your symptoms so far?", "Have you been to a priest, a healer, or other resource in the community?" and "In your culture, what is the best way to treat the symptoms that you have described?" are a good start to these conversations.

In bridging indigenous practices with westernized models of treatment, it is sometimes useful to partner with, and consult with local herbal doctors or Voodoo practitioners, depending on the illness, level of acculturation, and interest of the client. Although consultation with indigenous healers may become necessary, the process for establishing such partnerships in the community may be daunting to many clinicians. Whereas other authors (Trimble & Fisher, 2006; Goodenough, 1996) provide specific strategies for making those connections, it is sufficient to say that the more involved clinicians are in the community of interest, the more they will learn how to make those contacts, and whom to contact. When in doubt, seek the guidance of the leaders of the community.

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Conclusion Many years of clinical practice and research experience with Haitian clients has taught us that treatment that fails to integrate clients' culture will also fail to elicit positive behavioral change. Hence, we strongly recommend that treatment of Haitians be informed by the cultural traditions of the Haitian people, be integrated with community resources, and be linked to traditional folk remedies that are central to the healing process within their culture.

…treatment that fails to integrate clients' culture will also fail to elicit positive behavioral change. Hence, we strongly recommend that treatment of Haitians be informed by the cultural traditions of the Haitian people, be integrated with community resources, and be linked to traditional folk remedies…

References Bernal, G., Jiménez-Chafey, M., & Domenech Rodríguez, M. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), 361-368. Colin, J. M., & Paperwalla, G. (1996). Haitians. In J. G. Lipson, S. L. Dibble, & P. A. Minarik (Eds.), Culture & nursing care: A pocket guide (pp. 139-154). San Francisco, CA: University of California, Nursing Press. Etienne, C. (2007), Conference address. In "Cultural Diversity Presents Special Challenges for Mental Health." Retrieved June 6, 2010, from http://www.paho.org/english/dd/pin/pr071010.htm. Goodenough, W. H. (1996) "Culture" Encyclopedia of Cultural Anthropology. New York: Henry Holt. Kirkpatrick, S. M., & Cobb, A. K. (1990). Health beliefs related to diarrhea in Haitian children: Building transcultural nursing knowledge. Journal of Transcultural Nursing, 1, 2-12. Laguerre, M. S. (1984). American odyssey: Haitians in New York City. Ithaca, NY: Cornell University Press. Miller, N. L. (2000). Haitian ethnomedical systems and biomedical practitioners: Directions for clinicians. Journal of Transcultural Nursing, 11, 204-11. Nicolas, G., Schwartz, B. & Pierre, E. (2010). Weathering the storms like Bamboo: The strengths of Haitians in coping with natural disasters. In A. Kalayjian, D. Eugene, & G. Reyes (Ed.) International handbook of emotional healing: ritual and practices for resilience after mass trauma. Westport, CT: Greenwood Publishing Group, Inc. Nicolas, G., DeSilva, A., Grey, K., & Gonzalez-Eastep, D. (2006). Using a Multicultural lens to understand illnesses among Haitians living in America. Professional Psychology: Research and Practice, 37, 702-707. Nicolas, G., Desilva, A. M, Prater, K., & Bronkoski, E. (2009). Empathic Family Stress as a Sign of Extended Family Connectedness in Haitian Immigrants. Family Process, 48, 135 - 150. -XLIV-

Nicolas, G., Desilva, A., Subrebost, K., Breland-Noble, A., Gonzalez-Eastep, D., Prater, K., et al. (2007). Expression of depression by Haitian women in the U.S.: Clinical observations. American Journal of Psychotherapy, 61, 83-98. Prince, L. (2005). Medsen fey (leaf doctor). Retrieved September 4, 2008, from http://www.geocities.com/medsen_fey/index.html. Trimble, J. E., & Fisher, C. B. (2006). Handbook of ethical considerations in conducting research with ethnocultural populations and communities. Thousand Oaks, CA: Sage Publications. Guerda Nicolas, PhD – As a multicultural (Haitian American) and multilingual psychologist (Spanish, French, and Haitian Creole), Geurda’s research is reflective of her background and interests. Her current research centers on partnering with ethnically diverse and immigrant communities to develop culturally effective mental health interventions to combat depression, address issues of racism and racial discrimination stress, enhance the racial and ethnic identity development of children and adolescents, and promote individual, family, and community well-being. María José Rendón is a third-year student in the Counseling Psychology PhD program at the University of Miami. María José's research focuses on cultural adaptation of measures and treatments for ethnic and cultural minorities.

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Respecting Traditional Healing: A Journey of Understanding Where Spirituality and Cultural Competence Intersect Patricia Isaac, PhD Empire State College – SUNY Three years after leaving the Navaho Reservation, where I was once employed as a school psychologist, I find the knowledge I gained while being there is with me still. In retrospect, my life was changed forever. My personal worldview was challenged and expanded with every encounter. A large part of my responsibility comprised of spending countless hours in Individualized Education Program-IEP meetings. During these meetings, parents and students shared the advice they sought from a traditional Patricia Isaac, PhD healer. Through my multicultural counseling lens I understood why traditional healing was important and of value to the family. Yet I felt woefully inadequate in my ability to truly understand the profundity of traditional healing. It was my desire to learn more in a respectful manner because the situation demanded it. In truth, one does not go about asking such direct and personal questions about healing ceremonies in an IEP meeting. Over time I learned about traditional healing through sustained personal contact and friendships with my fellow school psychologists, the mental health counselors, native teachers and staff, administrators, friends and the families I served. I was fortunate enough to be trained by a school psychology supervisor, who I consider to be one of my greatest teachers, Dr. Cecelia Yazzie. Under her firm and watchful eye, I navigated through the intricate cultural norms of the Navaho. I learned to listen quietly and wait until all the speaking was done before I spoke. I did not always get this right. There were several occasions where Dr. Yazzie admonished me for speaking too directly or sustaining eye contact too long. It was expected that I visit students at their homes. In those conversations with a translator I learned how to enter the home respectfully. I learned to let the family tell me their story. Up until January 2007, my understanding of traditional healing was still more cerebral. However, all of that changed when I was in a second car accident in less than a year. My brother, Mark Standing Eagle Baez, told me I needed a ceremony and I didn't take him seriously after the first accident. He insisted after the second accident that I have a ceremony and I acquiesced. In fact my Director, Assistant Director and close friends insisted as well. -XLVI-

I cannot describe the ceremony, but will discuss what I brought from it. It was a fellowship where close friends brought their good intentions. I had not felt so loved and cared for as I did that cold January night. We formed very deep bonds of friendship that still connects us today through space and time. My reason for sharing this personal account is two-fold: first to honor those individuals who patiently helped and befriended me during my stay on the Navaho reservation; and second is to share my experience of being an outsider and the importance of being culturally responsible. I formulated guidelines on being culturally responsible based on these experiences; and continue to use them in my work with teachers and in diverse communities. The Importance of Being Culturally Responsible ! ! ! ! ! ! !

It is very important to enter the community in a respectful manner by not bringing your expectations, judgments or making assumptions about the community Quietly observe and wait until you are approached by members in the community (in some communities) Ask questions when appropriate Offer a hand when appropriate Understand your purpose for being there Be respectful of their use of spiritual healing Be respectful of sacred places and where ceremonies take place Patricia Isaac, PhD earned her Doctorate in Educational Psychology – School Psychology from Northern Arizona University. Prior to her work on the Navaho reservation she was involved in a school-wide behavior program on the Havasupai reservation and did her doctoral practicum on the Hopi reservation. Presently, Dr. Isaac is on faculty with SUNY Empire State College in the Master of Arts in Teaching Program where she trains pre-service teachers and mentors teachers in high need schools.

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EXEMPLARY TARGETED INTERVENTIONS

Legislative Efforts to Eliminate Native-Themed Mascots, Nicknames, and Logos: Slow but Steady Progress Post-APA Resolution Jesse A. Steinfeldt, PhD Indiana University Lisa Rey Thomas, PhD University of Washington Mattie R. White, MS, MEd Indiana University APA Resolution Calling for the Immediate Retirement of Native-Themed Mascots In A ugust, 2005 , the A m e ric a n Psychological Association Council of R epresen tatives adopted the A P A Resolution Recommending the Immediate Retirement of American Indian Mascots, Symbols, Images, and Personalities by Schools, Colleges, Universities, Athletic Teams, and Organizations (APA, 2005). The adoption of this resolution represents the courage, dedication, and grit of many who engaged in complex and difficult discussions with APA governance and membership. Of most concern to those opposed to the adoption of the resolution was the scarcity of scientific evidence of the harm perpetrated on American Indian and Alaska Native people by the use of Native-themed mascots, nicknames, and logos. One has to wonder at the irony of this concern. Academic institutions have a long history of ethnocidal, if not genocidal, practices directed towards Native people beginning with the boarding school era (Brave Heart & DeBruyn, 1998; Witko, 2005) and continuing today where Native people are subjected to racism, stereotyping, and marginalization in many, if not most, academic settings. Thus, this scarcity of scientific evidence makes sense — why would a Native community agree to participate in research conducted by the very institutions that have, and do, perpetrate harm on their members? Of most concern to those opposed to the adoption of the resolution was the scarcity of scientific evidence of the harm …One has to wonder at the irony of this concern. Academic institutions have a long history of ethnocidal, if not genocidal, practices directed towards Native people…Thus, this scarcity of scientific evidence makes sense —…why would a Native community agree to participate in research conducted by the very institutions that have, and do, perpetrate harm on their members?

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Still, this is a journey of hope and commitment for those psychologists and allies dedicated to the right of all people to be psychologically healthy and to live in our society free from violations of civil rights. Of note is the recent increase (albeit slow and inadequate) of American Indian and Alaska Native psychologists who are developing research partnerships with Native communities that are responsive to the research needs of the communities and inclusive of the issues surrounding the impacts of racism, stereotyping, prejudice, and, yes, Native-themed mascots. As these research partnerships move forward, we will continue to see Jesse A. Steinfeldt, PhD more scientific evidence emerging in the literature that addresses the harms experienced by Native communities as well as the strengths and resiliencies that have kept Native communities healthy. The APA Resolution Recommending the Immediate Retirement of American Indian Mascots, Symbols, Images, and Personalities by Schools, Colleges, Universities, Athletic Teams, and Organizations represents an important step in this journey of hope and commitment. This brief article will describe recent legislation that is another important and historical step on this journey toward the eradication of Native-themed mascots, nicknames, and logos. American society is inundated with stereotypic representations that appropriate American Indian culture (Merskin, 2001). One need not look further than the aisles of a grocery store (e.g., Land o' Lakes Butter), the local YMCA (e.g., Y-Princess camps), cars on the street (e.g., Jeep Cherokee), the floor under one's feet (e.g., Mohawk carpet), or simply turn on ESPN to see the highlights of the Washington Redskins game. These omnipresent images perpetuate misinformation and stereotypes about American Lisa Rey Thomas, PhD Indians, including the stereotype of the noble savage, the bloodthirsty savage, and that American Indians are a historic race that only exists in past-tense status. These stereotypes threaten the psychological functioning of American Indians and remind American Indian communities of the narrow view that society has of them (Fryberg, Markus, Oyserman, & Stone, 2008) One of the most prominent mechanisms of perpetuating societal stereotypes and misinformation about American Indians is the use of American Indian names, culture, and imagery in sports (King, Davis-Delano, Staurowsky, & Baca, 2006). According to scholars from a variety of disciplines outside of psychology, sports-related representations of American Indians (e.g., Redskins, Braves, Indians, Fighting Sioux) are problematic because -XLIX-

they (a) misuse sacred cultural symbols and spiritual practices; (b) perpetuate racist stereotypes of American Indians; (c) deny American Indians control over societal definitions of themselves; and (d) create a racially hostile environment for all students (Baca, 2004; Fenalon, 1999; King, Staurowsky, Baca, Davis, & Pewewardy, 2002; Pewewardy, 1991; Russel, 2003; Staurowsky, 2004; Staurowsky, 2007; Williams, 2006, 2007). In 2005, the American Psychological Association validated these interdisciplinary contentions by passing a resolution recommending the immediate retirement of American Indian mascots, symbols, images and personalities by schools, colleges, universities, athletic teams and organizations because this practice (a) undermines the educational experiences of members of all communities; (b) establishes an unwelcome and hostile learning environment for American Indian students; (c) has a negative impact on the self-esteem of American Indian children; (d) undermines the ability of American Indian Nations to portray accurate and respectful images of their culture; and (e) may represent a violation of the civil rights of American Indian people (APA, 2005). Emerging psychological research (e.g., Fryberg et al., 2008; Kim-Prieto, Goldstein, Okazaki, & Kirschner, 2010; Steinfeldt & Wong, 2010; Steinfeldt et al., in press) has supported this resolution by investigating and reporting the negative psychological effects of these race-based mascots, nicknames, and logos. In spite of emerging psychological research and institutional condemnation (in addition to APA, over 115 professional organizations have produced similar resolutions), the longstanding omnipresence of stereotypic images of American Indians in society (Merskin, 2001) creates the impression that these images must be acceptable (King et al., 2006). These images in sport have been hegemonically woven into the fabric of society, often disallowing a discussion about the possibility that this practice could be offensive, racist, or harmful to American Indians. Thus, although research and education are essential components for effectuating long-term attitudinal change, legislative enforcement is needed to penetrate this hegemony so that education, research, and the perspective of others can become a part of the discussion. There are a variety of legislative mechanisms that have been designed to effectuate change at multiple levels of sport in society. For example, at the level of professional athletics, a lawsuit has challenged the trademark of the Washington Redskins. At the collegiate athletic level, the NCAA enacted a policy in 2005 that prohibits teams with Native-themed mascots from participating in postseason play. However, at the level of high school, middle school, and grade school athletics, there has been no state-wide legislation to address this issue-until now. On May 5, 2010, Wisconsin made national history when Governor Jim Doyle signed Senate Bill 25 (WI SB-25) into law. As a result, Wisconsin became the first state to enact legislation that intends to offer a fair process to address the use of race-based mascots, nicknames, and logos in schools. Prior to this legislation, if a community member were to raise the issue that a school's Native-themed mascot, nickname, or logo is offensive or produces negative -L-

psychological outcomes, their claim is often rejected — often in a hostile manner — by the local school administration, community, and school board. Even if one were to be granted a hearing-and presented an armory of legitimate evidence — the school board often chooses to reject their claim, usually based on their own desire to maintain tradition and based on false contentions that this practice honors American Indians.

On May 5, 2010, Wisconsin made national history when Governor Jim Doyle signed Senate Bill 25 (WI SB-25) into law. As a result, Wisconsin became the first state to enact legislation that intends to offer a fair process to address the use of race-based mascots, nicknames, and logos in schools. …In this process, scientific evidence can be held up against contemporary arguments of honor and tradition that are often used as trump cards…

However, this new legislation seeks to change this dynamic so that members of racial or ethnic minority groups no longer bear the burden of proof in matters where they face racial discrimination and educational disenfranchisement. According to WI SB-25, if a resident of a school district files a complaint that indicates that the school mascot, nickname, or logo promotes (a) discrimination; (b) pupil harassment; or (c) stereotyping, this law now requires the matter to go to an external third party (i.e., State Superintendant, Department of Public Instruction) where a more legitimate process can conceivably occur. In this process, scientific evidence can be held up against contemporary arguments of honor and tradition that are often used as trump cards in the discussion at the local level about why the race-based mascot, nickname, or logo should be retained. It is important to note that this law does not directly ban race-based mascots, nicknames, or logos. Instead, this law intends to initiate a fairer and less biased process to critically examine this issue. If this process determines that a school district's mascot, nickname, or logo does promote discrimination, pupil harassment, or stereotyping, then the school district can be fined up to $1,000 per day until they remove the mascot, nickname, or logo in order to be in compliance with the law. Legislation such as WI SB-25 can be considered a complementary extension of APA's 2005 resolution, and this legislation can be used as a template for other states to initiate a fairer process to evaluate if the practice of race-based mascotery promotes discrimination, pupil harassment, and/or stereotyping. This process is important because people who raise this issue to the local power structure often face discrimination and retribution for their complaints, and the local school board often minimizes the issue and claims that American Indian communities should focus their attention on more serious issues they are facing (e.g., alcoholism, Type II diabetes). However, Mattie R. White, MS, MEd

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according to Davis (2002), if mainstream Americans can't understand the problem of Native-themed mascots, nicknames, and logos, they can't understand sovereignty or other issues affecting the quality of life for American Indian communities. As it relates to psychologists, an awareness of the marginalization of American Indians through the practice of race-based mascotery can help mental health professionals examine their own stereotypes and gain a more comprehensive understanding of their American Indian clients by including unique aspects of their reality that may contribute to their worldview and even their presenting concerns (Steinfeldt &Wong, 2010). Conclusion In sum, emerging legislative enforcement …emerging legislative enforcement (e.g., (e.g., WI SB-25) can enhance the WI SB-25) can enhance the effectiveness effectiveness of professional organizational of professional organizational resolutions (e.g., APA, 2005), scientific psychological resolutions (e.g., APA, 2005), scientific research, and educational efforts that aim psychological research, and educational to end the use of mascotery.. Doing so efforts that aim to end the use of mascotery. can hasten the process by which this As a result, it becomes a reasonable contemporary practice becomes a question to ask — in 30 years, how will we historical footnote… look back at this period of history, and how will we judge our society's continued engagement in this racist practice of appropriating another culture for use as sports mascots, nicknames, and logos? Similarly, it seems so obviously objectionable when we use hindsight to look back at the period in our history when Blacks were not allowed to drink from the same drinking fountains as Whites. However, it is important to understand that at the time, this too was a practice that was hegemonically woven into the fabric of society — it was seen by the majority of people as part of the normal order of society, and it took legislative efforts (e.g., Civil Rights Act) to accelerate the process of change. Thus, legislation like WI SB-25 can be an important component of a multifaceted approach to encourage people to stop the practice of appropriating and marginalizing another culture through the use of race-based mascots, nicknames, and logos. Doing so can hasten the process by which this contemporary practice becomes a historical footnote about stereotypes and civil rights violations, rather than an ongoing practice of stereotyping and violating the civil rights of a group of people. References American Psychological Association (2005, October 18). APA resolution recommending the immediate retirement of American Indian mascots, symbols, images, and personalities by schools, colleges, universities, athletic teams, and organizations. Retrieved online from http://www.apa.org/pi/oema/resources/policy/indian-mascots.pdf. -LII-

Baca, L. R. (2004). Native images in schools and the racially hostile environment. Journal of Sport and Social Issues, 28, 71-78. Brave Heart, M. Y., & DeBruyn, L. M. (1998). The American Indian Holocaust: Healing historical unresolved grief. American Indian and Alaska Native Mental Health Research, 8, 56-78. Davis, L. R. (2002). The problem with Native American mascots. Multicultural Education, 9, 11-14. Fenelon, J. V. (1999). Indian icons in the World Series of racism: Institutionalization of the racial symbols of Wahoos and Indians. Research in Politics and Society, 6, 25-45. Fryberg, S. A., Markus, H. R., Oyserman, D. & Stone, J. M. (2008). Of warrior chiefs and Indian princesses: The psychological consequences of American Indian mascots. Basic and Applied Social Psychology, 30, 208-218. Kim-Prieto, C., Goldstein, L.A., Okazaki, S., & Kirschner, B. (2010). Effect of exposure to an American Indian mascot on the tendency to stereotype a different minority group. Journal of Applied Social Psychology, 40, 534-553. King, C.R., Davis-Delano, L., Staurowsky, E., & Baca, L. (2006). Sports mascots and the media. In A. A. Raney & J. Bryant (Eds.), Handbook of Sports and Media (pp. 559-575). Mahwah, NJ: L. Erlbaum and Associates. King, C.R., Staurowsky, E. J., Baca, L., Davis, L. R., & Pewewardy, C. (2002). Of polls and prejudice: Sports Illustrated's errant 'Indian Wars'. Journal of Sport & Social Issues, 26, 381-402. Merskin, D. (2001). Winnebagos, Cherokees, Apaches, and Dakotas: The persistence of stereotyping of American Indians in American advertising brand names. Howard Journal of Communications, 12, 159-169. National Collegiate Athletic Association (2005). Native American mascots. Retrieved online from http://www.ncaa.org/wps/portal/ncaahome?WCM_GLOBAL_CONTEXT=/wps/wcm/co nnect/ncaa/NCAA/Media%20and%20Events/Press%20Room/Current%20Issues/General %20Information/native_american_mascots.html Pewewardy, C. D. (1991). Native American mascots and imagery: The struggle of unlearning Indian stereotypes. Journal of Navajo Education, 9, 19-23. Russel, S. (2003). Ethics, alterity, incommensurability, honor. Ayaangwaamizin: The international journal of indigenous philosophy, 3, 31-54. Staurowsky, E. J. (2004). Privilege at Play: On the legal and social fictions that sustain American Indian sport imagery. Journal of Sport and Social Issues, 28, 11-29. Staurowsky, E. J. (2007). "You know, we are all Indian": Exploring White power and privilege in reactions to the NCAA Native American mascot policy. Journal of Sport and Social Issues, 31, 61-76. Steinfeldt, J. A., Foltz, B. D., Kaladow, J. K., Carlson, T., Pagano, L., Benton, E., & Steinfeldt, M. C. (in press). Racism in the electronic age: Role of online forums in expressing racial attitudes about American Indians. Cultural Diversity and Ethnic Minority Psychology. Seinfeldt, J.A., & Wong, Y. J. (2010). Multicultural training on American Indian issues: Testing the effectiveness of an intervention to attitudes toward Native-themed mascots. Cultural Diversity and Ethnic Minority Psychology, 16, 110-115. Williams, D. M. (2006). Patriarchy and the 'Fighting Sioux': A gendered look at racial college sports nicknames. Race, Ethnicity, & Education, 9, 325-340. -LIII-

Williams, D. M. (2007). Where's the honor? Attitudes toward the "Fighting Sioux" nickname and logo. Sociology of Sport Journal, 24, 437-456. Witko, T. (2005). In whose honor: Understanding the psychological implications of American Indian mascots. California Psychologist, January Issue. Jesse A. Steinfeldt, PhD is a Counseling Psychologist of Oneida descent and an Assistant Professor in the Department of Counseling and Educational Psychology at Indiana University. In addition to receiving clinical training at the Oneida Behavioral Health Center and conducting research on the psychological effects of Native-themed mascots/nicknames/logos, Dr. Steinfeldt has given presentations on race-based mascotery at both Tribal Colleges and Predominantly White Institutions (PWI). Jesse's professional identity is also influenced by his degree in Sport Psychology and his interests in counseling student-athletes and training graduate students to provide psychological services within the athletic domain. Lisa Rey Thomas, PhD (Tlingit) is a Research Scientist at the Alcohol and Drug Abuse Institute at the University of Washington and has 20 years of experience working with American Indian and Alaska Native (AIAN) communities with a focus on community based and culturally grounded research that emphasizes strengths and resiliencies. Dr. Thomas serves on numerous committees and task groups, including the American Psychological Association's (APA) Committee on Ethnic Minority Affairs (Chair, 2007), APA Div 18 Psychologists in Indian Country Section (Chair, 2007-2009), Immediate Past Co-Chair for the Native Research Network, and Member-at-Large of APA's Division 45 Society for the Psychological Study of Ethnic Minority Issues. She is a member of APA Divisions 18, 27, 45, and 56, is also a member of the Society of Indian Psychologists, and serves on the planning team for the 2011 and 2013 National Multicultural Conference and Summits. Mattie R. White, MS, MEd is the Assistant Athletic Director for student services at Indiana University (IU) and a first-year doctoral student in the IU Counseling Psychology program with plans to specialize in Sport Psychology. Mattie received both her bachelor's degree in journalism (2002) and master's of education (2004) from Ohio University, and completed a second master's degree in athletic administration (2008) at Indiana University. Prior to coming to IU, Mattie served as the Assistant Director of campus programs for multicultural life at Macalester College where she was responsible for campus wide multicultural programming, advising all cultural student organizations, and overseeing the Cultural House.

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Wuyámush (Be Happy, Be Well – Pequot): Adapting a Mental Health and Healing Experience to a Southeast New England Native American Community Gretchen Chase Vaughn, PhD Vaughn Associates, New Haven, CT Michele Scott, BA Executive Project Director, MPTN Circles of Care Project Mashantucket, CT

Tribal Com m unity Members Who Have Taken Part in the MPTN Circles of Care Project

Overview

Since colonial times the systematic process of dispossessing Native Americans from their land and relabeling them racially — coined "pencil genocide" (Richmond, 2010) — so as not to acknowledge Native American racial/ethnic identity, has lingered in this community as an invisible pain. However, the counter narrative…is the ability …to transcend colonial boundaries and make strategic decisions to maintain ethnic identity culture, and physical, mental, spiritual and environmental well-being.

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Native American children in southeastern New England have to confront many stereotypes, myths and barriers that have been perpetuated over four hundred years: first, being part of the "invisible minority" and confronting the mythology that there are no Indians east of the Mississippi. Since colonial times the systematic process of dispossessing Native Americans from their land and relabeling them racially — coined "pencil genocide" (Richmond, 2010) — so as not to acknowledge Native American racial/ethnic identity (Mancini, 2008), has lingered in this community as an

invisible pain. Our community is now confronting how this historical, intergenerational trauma impacts on the health and well being of our youth. However, the counter narrative to this part of history is the ability of the southeast New England Native American (SNENA) community to transcend colonial boundaries and make strategic decisions to maintain ethnic identity culture, and physical, mental, spiritual and environmental well-being. The Mashantucket Pequot Tribal Nation's Circle of Care (MPTN COC) is a three year planning project funded by the Substance Abuse and Mental Health Services Administration( SAMHSA). The project is led by a Native American Advisory Board to help southeastern Connecticut Tribal communities collaborate with providers in order to design a culturally appropriate mental health service model for youth and families. We listened to the voices of our community. Our elders advised us that the historical and cultural adaptive practices should be used to help the youth and families today. Our youth recommended that we link Gretchen Chase Vaughn, PhD popular contemporary art forms with mental health awareness through poster and logo contests, poetry, video, music, photography. Providers suggested the need for ongoing dialogue where mental health providers learn about the community needs and culture, and community members learn about services. In response to these strategic goals the MPTN COC has sponsored a Mental Health Awareness Fair for the past two years in conjunction with National Children's Mental Health Awareness Day (NCMHAD) sponsored by SAMHSA. Mental Health Awareness Day This event was designed to engage the community in the vision of the MPTN COC - that southeast New England Native American youth and families will have complete access to comprehensive, culturally appropriate mental health services with linkages to agencies collaborating in a system of care. A planning committee was formed which included Tribal community members, providers, parents, youth and elders. During bi-monthly meetings held before the event, community members and providers were able to interact as equals and worked to develop interactive booths which would be informative about both mental health and cultural healing practices. Michele Scott, BA

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There were informational tables and SNENA traditions of adaptation, passing interactive booths addressing various mental knowledge through oral history, and health issues (including a booth representing maintaining inter- and intra- Tribal the National Indian Child Welfare community connections were used to adapt the Children's Mental Health Association, NICWA). Booths included Awareness Day activities.…The cultural disabled bowling, yoga, meditation, interactive booths allowed youth to not communication exercises, team building, only acknowledge problems in our good touch/bad touch, listening to popular community , but to also recognize the songs to identify the mental health themes, traditions and cultural practices that can drawing and journaling about feelings, etc. be used to heal those problems. Mental health providers were able to meet and describe their services to Native American youth and families in a non-threatening environment. Raffle prizes were awarded to youth who visited each booth. Cultural Adaptation SNENA traditions of adaptation, passing knowledge through oral history, and maintaining inter- and intra- Tribal community connections were used to adapt the Children's Mental Health Awareness Day activities. The planning committee decided that the event should always include cultural stations/activities. The cultural interactive booths allowed youth to not only acknowledge problems in our community , but to also recognize the traditions and cultural practices that can be used to heal those problems. Our follow-up feedback indicated that the youth seemed the most engaged with the cultural stations, such as the following. !

Pequot Language & Art Project – youth drew a picture of something that made them feel happy. They also learned the imperative "Be Happy/Be Well" in Pequot (Wuyámush) [adapted from the "My Feelings are a Work of Art" component of NCMHAD].

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!

Mashantucket Pequot Museum & Research Center (MPMRC) provided displays and treats from the exhibit that dealt with "tricky treats" that included diabetes prevention stories for Native American children [Eagle books diabetes prevention stories were developed by the Center for Disease Control].

!

Foods of Our Culture – youth learned about the foods that sustained the community hundreds of years ago and how to incorporate them into everyday living now so that the youth can remain healthy. The Mashantucket Pequot Cultural Department Coordinator explained to the youth that certain foods improve a person's brain function and mental health and that these foods were essential to our tribal history and traditional ceremonies and events.

!

Family Tree Exercises – Eastern Pequot and Mashantucket Pequot Elders were present to teach our youth how closely the two Tribal families are connected.

!

Storytelling – a Native American elder was able to tell stories to youth and parents and explain the healing power of storytelling.

Conclusion This activity has been a highly successful method to bring attention to both mental health and traditional cultural practices as resources for healing in our community. Over the past two years with support from the Native American Advisory Board, Tribal Councils, Tribal government departments, and local providers, approximately 400 community members have participated. Local providers also had the opportunity to meet with and learn from members of the southeastern New England Native American community. References Brave Heart, M. Y. H. (2005). Substance abuse, co-occurring mental health disorders, and the historical trauma response among American Indians/Alaska Natives. Research Monograph, Bureau of Indian Affairs, DASAP, Washington, DC. Cross, T.L. (2003). Culture as a Resource for Mental Health. Cultural Diversity and Ethnic Minority Psychology, V. 9(4), 354-359 Mancini, J.R. (2008). "In contempt and oblivion": The Transformation of Connecticut's Indian Population in the Era of the American Revolution. In D. Naumec (Ed.), Proceedings of the Northeastern Native Peoples & the American Revolutionary Era: 1760-1810. Mashantucket: Mashantucket Pequot Museum & Research Center. Lamb-Richmond, T. (2010). Teaching about American Indians of the Northeast: Who is telling the story? Workshop Presentation, Mashantucket Pequot Museum & Research Center, Mashantucket, CT. April 24, 2010. -LVIII-

Gretchen Chase Vaughn PhD is a clinical psychologist and principal of Vaughn Associates, a consulting firm which focuses on behavioral health, evaluation and culturally competent practice to improve the lives of underserved communities of color. She received her doctorate from The George Washington University and currently serves as the Evaluator for the MPTN Circles of Care Project. Michele Scott BA, is an enrolled member of the Mashantucket Pequot Tribal Nation. She received her Bachelor of Arts in Psychology and American Studies from Columbia University. She is currently the Executive Project Director of the MPTN Circles of Care Project and is dedicated to program development focusing on mental health, cultural competency and social justice.

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Honoring Children, Making Relatives: Indigenous Traditional Parenting Practices Compatible With Evidence-based Treatment Dolores Subia BigFoot, PhD Beverly W. Funderburk, PhD University of Oklahoma Health Sciences Center Cultural/Historical Background The Indian Country Child Trauma Center designed a series of American Indian and Alaska Native (AI/AN)1/ transformations of evidence-based treatments. Parent-Child Interaction Therapy (PCIT), an effective treatment model for parents who have either difficulty with appropriate parenting skills or children with behavior problems, was examined within the cultural framework of AI/AN parenting teachings. Honoring Children - Making Relatives, embeds the empirically based, assessment driven PCIT model within a framework that honors AI/AN traditional beliefs of wellbeing and parenting practices. Present day disparities within AI/AN Present day disparities within AI/AN populations can be traced to changes in populations can be traced to changes in the the political, economic, social, cultural, political, economic, social, cultural, and and spiritual pathways that previously spiritual pathways that previously served to hold tribal or village groups together and served to hold tribal or village groups provided the structure for family relations together and provided the structure for and social order. Boarding schools, family relations and social order. missions, military conflict, broken treaties, Boarding schools, missions, military oppression, exploitation, and removal conflict, broken treaties, oppression, undermined the structure of that order. exploitation, and removal undermined the structure of that order. Major concerns remain about the ability of vulnerable AI/AN parents to parent their children in a stable, healthy, non-violent environment.2/ Honoring Children - Making Relatives recognizes the old

1/

American Indian and Alaska Native terminology is used to describe the Indigenous people of the continental United States; other terms use in the literature include Indians, T reaty Indians, Tribal, Native Villages, Alaskan Native Villages, Native Corporations, Native American, Native, First Americans, Tribal Nations, First Nations, Indigenous Nations, American Indian Tribes, plus other terms; more information can be found at the websites listed in foot note 2.

2/

American Indian and Alaska Native people's service needs are well documented in Profiles of American Indian and Alaskan Native Populations in Various Settings, (U.S. Census Bureau, 2000). This publication presents the wide variation in demographic characteristics for all tribes, villages, and rancherias, and includes descriptors of housing, (continued...)

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wisdom that was applied to parenting and family relationships for many generations, the teachings and practices that were interrupted when the structure of the Indigenous social composition was almost destroyed. Examination of components of traditional parenting practices reveals that PCIT, an evidence-based treatment which combines elements of social learning, family systems, and play therapy techniques, actually reflects some traditional practices. PCIT uses live coaching of the parent during a play/discipline situation to attain specific skills in nurturing parent/child play interactions, effective instructions and consistent consequences. AI/AN cultural consultants assisted with the adaptation process to assure that the beliefs, practices, and understandings incorporated were consistent with AI/AN cultures. Developers or leading trainers of the treatment models were included to maintain fidelity to the model and clarify their perspectives.

Dolores Subia BigFoot, PhD

PCIT Reflects Indigenous Traditional Ways The nurturance practices in PCIT target goals compatible with traditional AI/AN beliefs about the "planting of good seeds," i.e., directing a child's thoughts and actions. Indigenous beliefs assumed that each child possessed qualities to develop into a worthwhile individual with caregivers e nc o u r a g ing c o rre c t be ha vior b y acknowledging traits that would be helpful as the child grew older. For example: "My son brings me pride because he helps keeps the shelter warm through his willingness to help with the fire," or "My daughter is considerate of my old bones because when I move about, she watches and helps me as I rise." Even small efforts by children were honored by family members who "tended that good seed." The use In the typical PCIT protocol, there is little or no discussion of family traditions and family values, particularly regarding discipline. The Honoring Families Making Relatives approach allows for discussion of traditions and beliefs about discipline.

2/

(...continued) population, sources of income, employability, education level, household members, and primary providers. Additional information on the mental health needs of American Indian and Alaska Native population can be found at www.ihs.gov; www.icctc.org; www.nihb.org; Additionally, proceedings on these same are available by the U.S. Senate Committee on Indian Affairs at http://indian.senate.gov/. For specific information on individual tribes or Native corporations, please visit their respective websites.

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of praise to encourage positive actions is an old AI/AN method of rearing children (BigFoot, 1989). In the typical PCIT protocol, there is little or no discussion of family traditions and family values, particularly regarding discipline. The Honoring Families - Making Relatives approach allows for discussion of traditions and beliefs about discipline. Children were not granted unlimited freedom in traditional AI/AN practices (BigFoot, 1989). A concept that has been widely described in AI/AN cultures is that of non-interference - let things happen the way they are meant to be. While the concept of non-interference is important in the traditional context of living in close quarters, maintaining peaceful relations with extended family, or allowing natural consequences to happen, non-interference was never intended to result in inaction in the face of grave potential harm. Presenting an alternative to an unsuccessful condition is not interfering but allowing a person to have choices. Historic skills in negotiations, treaty making, and especially tribal protocol, demonstrate that there is a place for active resolution of problems in AI/AN traditions. It is helpful to view discipline as the teaching of self control as opposed to only punishment. For many Tribes, self discipline is highly prized, as demonstrated by traditions of fasting, vision quests, endurance during ceremonies, or self denial in ceremonies. Adaptions for Engagement of AI/AN Families There is great beauty in American Indian Plains dancers in full regalia with twin bustles made of Eagle feathers and coordinated beadwork on leggings, armbands, and moccasins. There is not only form but there is function to their movements. There is great sophistication in tribal protocol depending on status (chief, headman, elder, visitor), activity (ceremony, meals, blessing), or purpose (recognition, sacrifice). Follow ing protocol to accomplish a positive outcome is not new for Indigenous people. Thus, it is helpful for many families to describe PCIT, or indeed any evidence-based treatment, as a structured protocol that provides boundaries and encourages respectful behaviors in much the same way a traditional dancer complies with dance protocol. Once AN/AI parents understand the structure and sequence of the protocol (e.g., behavioral coding, learning specific words, and meeting criteria) that serves to accomplish the broad outcome of improved warmth, cooperation, and mutual respect, they tend to not be distracted by it. There is great sophistication in tribal protocol depending on status (chief, headman, elder, visitor), activity (ceremony, meals, blessing), or purpose (recognition, sacrifice). Following protocol to accomplish a positive outcome is not new for Indigenous people. Thus, it is helpful for many families to describe PCIT,…as a structured protocol that provides boundaries and encourages respectful behaviors…

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With the mindset of following a proven protocol to achieve a desirable goal, the individual components of the EBT can be discussed using words that avoid jargon and incorporate familiar terms. For example, the PCIT clinical term, Behavioral Description (an important skill acquired in PCIT) was reframed as telling the story of the child's play. Another difficult requirement of PCIT is that of giving very specific praise to the child. Culturally, recognition of accomplishments often is given indirectly in AI/AN families. For example, a parent might say "Your Uncle will be proud when I tell him how well you listened today." Using culturally appropriate praise words like "honor" or "respect" or calling a child after a namesake, i.e., "little grandma" or "little grandpa" might be comfortable labeled praises for the Indigenous adult to use. This is another method in which a transformation of the wording was used while the basic intent and outcome remain unchanged.

Beverly W. Funderburk, PhD

Cultural Accommodation Process The cultural transformation of PCIT, Honoring Children-Making Relatives, did not change the basic PCIT tenets; rather the foundation is observed from a world view that can honor the teachings and the practices that have been part of AI/AN understandings for generations. Old wisdom does not lose meaning; its deeper truths only become more relevant with time. References BigFoot, D.S. (1989) Parent Training for American Indian Families. Unpublished manuscript. Dolores Subia BigFoot, PhD is an enrolled member of the Caddo Nation of Oklahoma and is an Assistant Professor in the Department of Pediatrics, University of Oklahoma Health Sciences Center. Dr. BigFoot is recognized for her efforts to bring traditional and spiritual practices and beliefs into the formal teaching and instruction of American Indian and Alaskan Native people and to the professionals who work with American Indian and Alaskan Native populations. Beverly W Funderburk, PhD is an Associate Professor of Research at the Center on Child Abuse and Neglect in the University of the Oklahoma Health Sciences Center's Department of Pediatrics. She conducts treatment and training in Parent-Child Interaction Therapy. Research interests include issues of training and dissemination in PCIT.

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Teaching American Indian Children about Mental Illness: Developing a Culturally Sensitive Curriculum about the Science of Mental Illness Rebecca K. Dogan, MA, PLMHP William J. Warzak, PhD Maurice Godfrey, PhD Munroe–Meyer Institute and The Department of Pediatrics University of Nebraska Medical Center Background The National Institutes of Health (NIH) has established a program to provide science education to children K-12. Entitled, "Science Education Partnership Award" (SEPA). This program funds initiatives throughout the country. Since 2005, Maurice Godfrey, PhD, Associate Professor at the University of Nebraska Medical Center (UNMC), has served as Principal Investigator for a SEPA program entitled: Breaking Barriers: Health Science Education in Native American Communities. Through the efforts of Dr. Godfrey and colleagues, initiatives to enhance science education have been provided to teachers and students in Rebecca K. Dogan, MA, some sixteen schools on six Indian reservations in Nebraska Through the efforts of Dr. Godfrey and South Dakota. In 2009, NIH provided a and colleagues, initiatives to enhance science education have been supplement to the primary SEPA award to provided to teachers and students in address issues related to mental illness and some sixteen schools on six Indian healthy behaviors. With William Warzak, PhD, reservations in Nebraska and South P r o f e ss o r o f c linical psyc h o lo g y a t Dakota. Monroe-Meyer Institute, UNMC, serving as Co-PI, we adapted curricula initially developed by the Biological Sciences Curriculum Study (BSCS), an NIH/NIMH supported non-profit program that is focused on designing educational science curricula for teachers and students. Our primary curriculum, The Science of Mental Illness, strives to enable students to make informed decisions regarding their own health and the health of others in the community by providing information about the science

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underpinning mental health and mental illness. Given the NIH initiative, the goal of the current project was to develop a mental health curriculum sensitive to American Indian values. Developing a Culturally Sensitive Curriculum Curriculum development presented a number of unique challenges, not the least of which was reconciling American Indian beliefs about mental illness with current research and commonly accepted scientific understanding of mental illness. Our efforts to present a science curriculum sensitive to American Indian cultural beliefs required a multi-month effort to obtain a) relevant cultural research, b) needs assessment and feedback from local tribal representatives regarding initial drafts of the curriculum, and c) tribal representatives to deliver a portion of the curriculum. It is important to note that the curriculum was not focused on mental health issues in the Native American community; but rather, was focused on the science of mental illness in general, while being sensitive to tribal and cultural issues perhaps not considered by the scientific community at large. Nevertheless, American Indians are at a higher risk for a number of psychological problems including suicide, substance abuse and depression (Gone, J. P., 2004), and these issues were addressed by the curriculum. Our efforts to present a science curriculum sensitive to American Indian cultural beliefs required a multi-month effort to obtain a) relevant cultural research, b) needs assessment and feedback from local tribal representatives regarding initial drafts of the curriculum, and c) tribal representatives to deliver a portion of the curriculum.

Review of the Literature An extensive literature review was completed to better understand how American Indians perceive mental illness, including etiologies and interventions. Indeed, American Indian views of traditional health care, which is a reflection of the dominant culture, often influence the extent to which Native Americans choose to access typical health care services (Plawecki, H. M., Sanchez, T. R., & Plawecki, J. A., 1994). For example, for many American Indians there is a link between spirituality, physical health, and healing that requires living in harmony with nature. Disharmony may result in illness (Sanchez, T. R., Plawecki, J.A., & Plawecki, H. M., 1996). As a result of these beliefs, tribal members may -LXV-

William J. Warzak, PhD

seek assistance from designated tribal members who can address disharmony through sacred ceremonies. Nevertheless, there are those who will seek treatment from both health care professionals and traditional healers (Sanchez, T. R., Plawecki, J. A., & Plawecki, H. M., 1996). It should be noted that American Indian culture is not monolithic (Jervis, L. L. & AI-SUPERPFP Team, 2009). Indeed, beliefs among different tribes may vary widely, thereby introducing another level of complexity in developing a curriculum anchored in science but sensitive to the cultural needs of several different tribes and traditions. Furthermore, providing education to American Indian students regarding the science of mental illness is not to dissuade people from the use of traditional practices but rather to reduce the stigma of mental illness and provide empirical evidence that disease does not develop from disharmony alone. With this understanding and additional knowledge American Indian children will be more capable of making informed decisions in the future about their health regardless of their choice of Native or Western treatment. Needs Assessment and Feedback from Community Members In addition to reviewing native health care beliefs and practices, a needs assessment was completed by 85 administrators and teachers in seven schools throughout Nebraska and South Dakota. The participants self-identified as Caucasian or affiliated with one or more of the following tribes: Santee, Yankton, Wichita, Ponca, Rosebud, Blackfeet, Winnebago, Sioux, Cheyenne, Prairie Band Potawatomi, Omaha, or Sisseton-Wahpeton. Assessment items included queries regarding whether or not the school had a mental health curriculum, if faculty were interested in addressing the science of mental health as a curriculum (e.g., current concepts and potential interventions for various disorders). In addition, participants were asked what issues may be Maurice Godfrey, PhD controversial or should be addressed with particular sensitivity given the cultural experiences of the students. Results from the needs assessment identified further interests of the participants, such as information regarding developmental disabilities, and suggested additional resources pertinent to students from specific tribes. Lastly, feedback regarding the initial curriculum was obtained from representatives of the local American Indian community.

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Obtaining Native Presenters Obtaining guest speakers to address various topics, particularly those related to historical trauma and how it relates to current beliefs about mental illness and mental health was crucial. Furthermore, supplemental readings from the Journal of the National Center on American Indian and Alaska Native Mental Health Research were provided and reviewed daily. These articles provided information applicable to American Indian culture while investigating mental health concerns from both Native cultural and scientific perspectives. The Final Curriculum The BSCS curriculum ultimately was enhanced by UNMC and community professionals to include presentations on Mood Disorders and Suicide, Developmental Disabilities, Addiction and Historical Trauma, among others, as well as a discussion of tribal resources available in local communities. It is our hope that this enhanced science curriculum will extend the awareness of mental illness by American Indian students and teachers. It is our goal to provide current scientific concepts regarding causes and treatments of mental health disorders while demonstrating respect for individual beliefs and Native American cultural identity. This work was supported by the Science Education Partnership Award (SEPA) from the National Center for Research Resources (NCRR) of the National Institutes of Health (NIH) # 1 R25 RR022707. References Gone, J. P. (2004). Mental Health Services for Native Americans in the 21st Century United States. Professional Psychology: Research and Practice, 35, 10-18. Jervis, L. L. & AI-SUPERPFP Team (2009). Disillusionment, faith, and cultural traumatization on a Northern Plains reservation. Traumatology, 15, 11-22. Plawecki, H. M., Sanchez, T. R., & Plawecki, J. A. (1994). Cultural aspects of caring for Navajo Indian clients. Journal of Holistic Nursing, 12, 291-306. Sanchez, T. R., Plawecki, J.A., Plawecki, H. M. (1996). The delivery of culturally sensitive health care to Native Americans. Journal of Holistic Nursing, 14, 295-307. Rebecca Dogan, MA, PLMHP is a Predoctoral Research Fellow at Munroe-Meyer Institute, University of Nebraska Medical Center. She has provided services to a variety of populations including but not limited to children with developmental disabilities, foster and kinship caregivers, as well as at-risk children from immigrant families.

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William J. Warzak, PhD is Professor of Psychology at Munroe-Meyer Institute, University of Nebraska Medical Center. He has provided clinical services to a variety of children, including Native American children through the Indian Health Service. Brain injury and elimination disorders comprise his primary research interests with an additional focus in graduate and professional training. Maurice Godfrey, PhD is an Associate Professor of Pediatrics, University of Nebraska Medical Center. He is the Principal Investigator of the SEPA grant, described above and has a longstanding interest in science education. In addition, he has a distinguished history as an investigator of connective tissue disorders and is considered an international expert in Marfan Syndrome.

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The Society of Indian Psychologists Gayle Morse, PhD Utah State University Pamela Deters, PhD SIP President Jacqueline Gray, PhD SIP President Elect The year 2010 marks the 23rd annual retreat and convention (June 25-29 in the Logan, Utah area) of the Society of Indian Psychologists (SIP), which is primarily c o m p r i s e d o f N a ti v e A m e r i c a n psychologists, psychology graduate students, and friends of Native people. SIP was developed solely for the purpose of bringing together Indigenous psychologists and mental health providers to advocate for the physical and mental well-being of Native peoples by increasing the knowledge and awareness of issues impacting Native mental health. Moving from a small group of Native mental health providers, SIP is now a well-established national organization and is one of four national ethnic minority psychological associations recognized by the American Psychological Association ( APA). The SIP annual convention has regularly been financially supported by APA, specifically the Office of Ethnic Minority Affairs (OEMA), Indian Health Service (IHS), and Utah State University's American Indian Support Project (USU AISP). SIP was developed solely for the purpose of bringing together Indigenous psychologists and mental health providers to advocate for the physical and mental well-being of Native peoples by increasing the knowledge and awareness of issues impacting Native mental health.

This gathering is of utmost importance to us not only as psychologists but as a Native community. During the retreat and convention we take the opportunity to renew, reinvigorate, and recommit ourselves to Native health and wellness. The three-day retreat sets the tone for the convention and embodies ceremony, spirituality, and community. While at the

…the community of Indigenous Psychologists is a very small membership of approximately 250 clinically trained American Indian and Alaska Native psychologists. Native people represent only 0.3% of 84,883 psychologists;…

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retreat we take the time to hike ancient mountains and ride on horseback as our ancestors have done for generations. Our main goal during the retreat is to come together as multiple Indigenous Nations, and receive the guidance and mentoring of our elders and spiritual leaders. Immediately following the retreat the two-day annual convention begins. The convention centers on research questions focused solely on indigenous issues. It is a warm and welcoming program for students to present their research ideas, as well as meet with Native mentors and nationally known Indigenous psychologists. These connections are important because the community of Indigenous Psychologists is a very small membership of approximately 250 clinically trained American Indian and Gayle Morse, PhD Alaska Native psychologists. Native people represent only 0.3% of 84,883 psychologists; therefore, this is an opportune time for students to meet with Native professionals who work with communities, who conduct research, and who are engaged in obtaining their college degrees (SAMHSA 2004). This convention at Utah State University (USU) has multiple purposes including time to get acquainted, renew old friendships, and discuss ideas, as well as disseminate knowledge and new information relevant to Native People. We are guided by our elders, while seasoned Native psychologists support new emerging native leaders, graduate students, and undergraduate students. Our students come from multiple American Indian and Alaska Native Indian into Psychology programs across the country including University of North Dakota, Oklahoma State University, University of Montana, University of Alaska and Utah State University. It is an honor to watch our students blossom from unsure undergraduates to confident graduate students who are eager to help their communities. This maturation process underscores the importance of mentoring programs to ensure the success of our American Indian students.

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Pam ela Deters, PhD

At this year's meeting, SIP created a journal to train American Indian student scholars, created a committee to help students negotiate the bewildering world of student funding, and affirmed its commitment to students at the general meeting of the SIP members. The students and psychologists have agreed to work toward an even stronger association through their membership in SIP, to support student involvement in the annual convention of the SIP, to mentor student involvement in the national American Psychological Association (APA), and to help students better understand possible funding for Jacqueline Gray, PhD their education as psychologists. In addition, this year we were joined by Indigenous faculty and students from New Zealand who have experienced many of the same difficulties American Indians have. We were able to embrace our New Zealand relatives to create ties and projects that will cement our international relationships and support our mutual advantage. We look forward to the growth of SIP and future retreats and conventions. For more information on SIP, go to: http://aiansip.org/. Gayle Skawennio (Nice Flowing Words) Morse, PhD is the Co-Director of the American Indian Support Program, a licensed Psychologist and assistant professor at Utah State University. She has conducted research in the areas of environmental health, Native American Culture, and mental health. She has presented findings in peer reviewed articles, as well as at international and national conferences. Pam Deters, PhD (Cherokee/Choctaw) is the current president of the Society of Indian Psychologists (SIP). She formerly worked at the University of Alaska Fairbanks as an Associate Professor and Director of the Alaska Natives into Psychology (ANPsych) program. Dr. Deters now works in private practice in Louisiana. Jacqueline Gray, PhD is president-elect for the Society of Indian Psychologists, a career navigator and mentor for the North Dakota IDeA Network for Biomedical Research Excellence, and an assistant professor in the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. Her work is in the areas of native health and mental health, suicide prevention, and ethical research in American Indian communities.

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Indigenous Mental Health - American Psychological Association

SPECIAL SECTION TABLE OF CONTENTS INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

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