Effects of Colonization on Indigenous Mental Health Treatments

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How Indigenous Communities Have Been Affected by Mental Health

Historical Trauma

Historical trauma is a concept defined as the complex, collective trauma undergone by a group of people who share a similar identity, whether that be nationality, ethnicity, or religious affiliation[1]. It is the effect of numerous destructive events that have physically and psychologically damaged a community over many generations. Historical trauma is considered collective in that many members of the group view the traumatic events as severe losses and experience analogous reactions to the trauma. When looking at mental health reactions, individuals experience a variety of negative mental health symptoms such as denial, agitation, anxiety, depression, intrusive thoughts, and nightmares[1]. Historical trauma is also characterized as intergenerational in that it is transmitted down to descendants who continue to identify with their ancestor’s suffering, although in a more subtle way. Children of survivors are more likely to have depression, anxiety, difficulty expressing emotion, and, most noticeably, increased stress vulnerability to future events[1]. Even those who are multiple generations removed from traumatic events are still significantly affected. In a study conducted among two large reserve communities, more than one-third (33.7%) of the respondents experienced daily thoughts about Indigenous culture loss, and 18% thought about losses stemming from residential schools at least once a week, despite the fact that they were not involved in the residential school movement. Historical trauma plays a major role in Indigenous mental health as it is a direct cause in depression, anger, PTSD, and feelings of unresolved grief[2]. This has also led to several destructive behaviours - such as physical violence, substance addictions, and suicide - that have been passed down and normalized among Indigenous communities.

Adverse Childhood Experiences

Adverse childhood experiences (ACEs) are potential traumatic experiences occurring during childhood that can have negative lasting effects on mental health and well-being[3]. There are three broad types of adverse childhood experiences: abuse, neglect, and household challenges[3]. Abuse includes physical, emotional, and sexual abuse. Neglect is also divided into physical and emotional neglect. Household challenges include witnessing domestic violence, household substance abuse, having a mentally ill person in the family, parental separation, or a criminal family member. Research shows that the greater the number of adversities, the greater the likelihood of mental health problems[3]. While ACEs affect all ethnicities in varying degrees, the Indigenous community is affected in a way different from other ethnicities due to their distinct experience with historical trauma. In a study conducted on the prevalence of ACEs among five ethnic groups,  the Indigenous community reported nearly four ACEs on average, which was the highest among the ethnic groups[4].

Abuse

Abuse comes in the form of physical, emotional, and sexual abuse. While other ethnicities experience abuse in many ways, much of the abuse within the Indigenous community stems from the abuse experienced initially in residential schools. Compared to other ethnic groups, one of the distinguishing factors of abuse committed against the Indigenous community is the prolonged and systematic manner in which the abuse was carried out. This has led to a higher rate of physical and emotional abuse among Indigenous families, as proven by the 2:1 overrepresentation of Indigenous children in the foster care system due to child maltreatment. There are also higher rates of sexual abuse of Indigenous children, as 25%-50% of Indigenous women have admitted to being victims of sexual abuse as children compared to a 20%-25% average rate within the non-Indigenous population[5]. Assaultive trauma is linked to several negative mental health outcomes, in particular to higher risks of PTSD[6]. Studies show that individuals who have suffered from physical and sexual abuse prior to adolescence, which is the case for many Indigenous residential school survivors, are five to ten times more likely to develop PTSD[6].

Neglect

Neglect is also a major issue arising from the negative effects of historical trauma in Indigenous communities. Many families are not able to function as a normal unit due to feelings of anger, shame, and victimization from being colonized. Studies have shown that investigations by child welfare systems for neglect were eight times greater for Indigenous children than non-Indigenous children[7]. Poor socioeconomic conditions combined with the intergenerational effects of historical trauma have led to such high concentrations of neglect among Indigenous families. For example, child removal policies, such as residential schools, have prevented knowledge of healthy parenting habits and instead resulted in negative parenting behaviours caused by the abusive environment of the boarding schools[7]. Indigenous parents may also suffer from guilt and depression due to historical trauma, which may impact parenting. Neglect compounds itself through one’s lifetime to cause a variety of mental illnesses in Indigenous youth and adults.

Household Challenges

The last type of ACEs is household challenges. These challenges are categorized into having a criminal family member, witnessing domestic violence, substance abuse, having a mentally ill relative, and parental separation. In almost every one of these categories, Indigenous communities have the highest rates. In a study comparing White children to Indigenous children in the USA, Indigenous children were 2-3 times more likely to have a parent who served time in jail (18% versus 6%), to have observed domestic violence (15.5% versus 6.3%), to have been a victim of violence/witnessed violence in their neighbourhood (15.9% versus 6.7%), to have lived with a substance abuser (23.6% versus 11.6%), and to have lived with a divorced/separated parent (33% versus 21.4%)[8]. Several factors have led to such extreme levels of household dysfunctions, such as historical trauma, higher poverty rates, and decreased access to education. Exposure to household challenges has proven to negatively impact mental health, as seen by significantly higher levels of depression, anxiety, ADHD, and suicide attempts[8].

Current Treatment Practices

Drug Therapy

The use of drugs, such as antidepressants, mood stabilizers, and anti-anxiety pills have steadily increased in the USA and have now become one of the central features of Western mental health treatment. In the span of 15 years, the amount of money spent on psychotropic drugs have gone from an estimated $2.8 billion in 1987 to over $18 billion in 2001[9]. In another study reviewing prescription drug claims of more than 2 million Americans from 2001 to 2010, research indicated that one in five adults were treated for at least one mental illness in 2010, which was a 22% increase from a decade before[10]. The dramatic rise of drug therapy been attributed to numerous factors, one of them being greater awareness among civilians that drug therapies are safe and effective[10]. There has also been a major increase in the variety of drugs available as well as the insurance coverage for prescription drugs. Furthermore, physicians have become more likely to prescribe psychotropic drugs as they have become safer, pose less threat to overdose, and have more tolerable side effects[9].

Psychotherapy

Psychotherapy has been a long-standing method of treatment for mental illnesses. In 1995, the US Consumer Report published an article that expressed the substantial benefits of psychotherapy for patients[11]. The analysis conducted from these responses concluded that treatment by mental health professionals “usually worked”[11]. The stance on the effectiveness of psychotherapy has had little change since then. In 2013, the American Psychological Association published an article that recognized the effectiveness of psychotherapy, stating that its effects are “widely accepted to be significant[,]…large[,]…and constant across most diagnostic conditions”[12]. The APA has also stated that psychotherapy is beneficial in that it gives patients various skills that they can use, even after therapy completion, to help manage their mental illnesses.

Current Treatment Practices as a Form of Colonization

While these treatments are valid and can be very effective for some people, the same cannot be said for the Indigenous community. The effects of colonization are still deeply embedded in most Western mental health treatments, which make them culturally insensitive and marginalizing for Indigenous individuals. The lack of knowledge about Indigenous populations, use of stereotypes and mainstream bias against Indigenous culture, and adoption of Western paradigms in medical knowledge are some reasons why many dominant mental health treatments are unsuitable for Indigenous communities. Since Indigenous cultures strongly believe in holistic medicine over pharmaceuticals, it is culturally inappropriate to force drug therapy onto Indigenous individuals as it is perpetuating Western, colonial ideals. The same can be said about psychotherapy. While psychotherapy is widely believed to be neutral and science-based, it is actually heavily influenced by the values of the Western Enlightenment. The idea that problems can be isolated and targeted with specific interventions, or that licensed professionals are best qualified to help the mentally ill are all Western assumptions of healing[13]. Thus, the use of mainstream psychotherapy on Indigenous mental health is actually a form of colonization. The hierarchy of the therapist and the patient that exists in psychotherapy may also be oppressive as the therapist, who holds more sociopolitical power, may unknowingly impose Western definitions of healing onto the patient and reject alternative belief systems[14]. Furthermore, Indigenous world-views on healing are usually labelled as alternative medicines and not deemed legitimate in mainstream practices, due to the common assumption that scientific Western health practices are superior to spiritual Indigenous health practices. Thus, enforcing mainstream interventions on Indigenous individuals becomes a form of colonization because it marginalizes Indigenous ideas and imposes Western world-views instead.

Recommended Practices

Indigenous-only Intervention

There are two main streams of alternative intervention methods for Indigenous communities. The first approach rejects all Western world-views and focusses only on Indigenous traditions. In particular, Indigenous intervention is grounded in the concept of the Medicine Wheel. The Medicine Wheel encompasses the four pillars of Indigenous wellness: spirit, body, mind, and environment[13]. Mental health is not a disease pertaining to just the brain, but is based on all four elements. According to Indigenous cultures, the core of one’s existence begins with one’s spirit and its relationship to the Creator. The spirit resides in a physical body, and the two are interconnected by the mind. In Indigenous culture, the mind is not only made up of cognitive elements, like memory, but also includes personality, judgement, and experience. Lastly, people exist in certain environments, such as one’s family or tribe. The Indigenous world-view believes that mental sickness begins with the spirit, which then infects the body and mind. Thus, positive mental health occurs when all four elements are well-balanced and in harmony. In order to achieve this harmony, this intervention method calls for a variety of therapeutic pathways in each of the four elements: ceremonies or dreams for the spirit, recreation and nutrition for the body, storytelling and reminiscing for the mind, and family and tradition for the environment[13]. All these therapeutic pathways are based solely on Indigenous cultural practices. This intervention approach differentiates from Western therapy in a number of ways. While Western professionals use linear cause-and-effect frameworks, Indigenous healers use a circular, interconnected framework between the four elements. Additionally, Western professionals emphasize treating the person, while Indigenous healers focus on treating the balance of the four elements. In these ways, the first type of alternative intervention method caters specifically to Indigenous philosophy.

Western and Indigenous Combined Intervention

The second approach to mental health intervention combines both Western and Indigenous therapeutic approaches. Studies have been conducted to explore the prospects of bridging evidence-based treatment (EBT’s) with culturally sensitive therapies (CST’s) as an effective way of helping Indigenous individuals[15]. Evidence-based treatment is defined as the “empirically supported interventions identified by the […] American Psychological Association”, which simply refers to Western psychotherapy[15]. Culturally sensitive therapies are incorporated into evidence-based treatments to create “culturally competent” services that are adapted to Indigenous experiences[15]. The aim of combining the two interventions is to utilize the benefits of both Western and Indigenous treatments while eliminating the colonial aspect of traditional Western therapy.

A study of this intervention method was conducted at an Indigenous healing lodge located in Canada. Many of the therapeutic activities at the lodge were a mix of both Western and Indigenous practices. For example, clients at the lodge received counselling from mental health professionals, which is a Western construction of therapy, but the discussions they had during these counselling sessions were based on Indigenous perspectives of healing. Clients at the lodge identified with four main themes in their process of Indigenous healing: emotional burdens, cathartic disclosure, self-as-project reflexivity, and impact of colonization. The first theme of emotional burdens referred to the mutual understanding between client and counsellor that the client had “carried” emotional burdens throughout their life due to childhood trauma and that the weight of these burdens was the source of later destructive behaviours and personal problems. Next, clients were to find relief from these burdens by confronting their pain through acknowledgment and verbal confession of past trauma. The third step of healing related to the theme of self-as-project reflexivity, where the individual must take this sense of catharsis and use it as a catalyst for a life-long healing process. Finally, the healing journey was completed as clients reclaimed their Indigenous heritage and faced the impacts of colonization on their sense of self. As seen by the case study, this intervention approach mixes Indigenous traditions with empirically-supported Western treatments to create a custom therapeutic approach for Indigenous mental health.


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