Native American

Native Americans or American Indians are the indigenous peoples of North America. In Canada, it is also common to refer to the original peoples as First Nations, aboriginal, or autochthones (French). Native Hawaiians and indigenous Americans of Central and South America are not discussed, although they share many of the same principles and practices. Ultimately, there is no perfect or correct generalization for North America’s original people, because the very concept of “Native American” was a political expediency when indigenous people sought unity in the face of common postcolonial challenges, including military, political, cultural, economic, social, and health. A morally acceptable term was also needed to substitute for the word savages and other demeaning labels or stereotypes common in postcontact discourse.

There is no single Native American or First Nations culture. There are more than 4.3 million indigenous Americans in the United States⁵⁸ and another 1.3 million in Canada,⁶⁷ which are divided into more than 1162 recognized Native governments: approximately 600 in Canada, 562 in the United States, and hundreds more in various stages of the recognition process.⁶¹ Approximately 225 Native languages are spoken in the United States, and another 50 in Canada.^3,61 A far greater number of North American indigenous languages are extinct or are no longer spoken fluently. These languages are divided into 50 language families, many as different from each other as Romance (e.g., Italian) from Sino-Tibetan.

Old Hollywood movies and popular literature characterized as “New Age”⁸⁰ promote a particular kind of generic Indian: in buckskins and feathered headdresses, speaking Tonto-like broken English, and frozen in popular imagination in western landscapes. Museum exhibits that I saw as a child did little to correct the impression that Native Americans were relics from the past rather than a people concerned about their future. Today’s Native Americans wear business suits rather than buckskins, prize higher education, and generally identify themselves as Christian (i.e., approximately 85% in the southeastern United States). They are patriots and volunteer in the armed forces in higher percentages than does any other ethnicity. They live in houses and apartments—not in tipis.

Indigenous Americans live in two worlds: the culture of their ancestors and that of the modern United States and Canada. Health care choices are influenced by this duality. Although Native Americans are more likely to seek an allopathic physician than a traditional tribal healer, there remains widespread respect for many traditional remedies, such as prayers, herbal medicines, counseling, and ceremonies. Sometimes ancient and modern healing methods are combined to create synergistic effects.^25,28 Prescription medicines smudged in sage smoke and prepared with prayer are believed to be more effective than other methods of administration. Counseling complements the sweat lodge for the treatment of post-traumatic stress disorder.¹² Among diabetes patients, nutrient ratios are managed with a traditional native diet by substituting indigenous grains such as amaranth and wild rice for high-glycemic starches such as potatoes and bread. Native healers have always practiced “holistic” or “integrative” medicine. These terms take on more meaning as Native Americans find creative ways to combine the old and the new.

Health

Like their Western counterparts, Native healers are concerned with relieving suffering, improving quality of life, and managing or curing disease. The World Health Organization’s definition of health is congruent with that of many Native American healers: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”⁸³ Native healers add to this definition two more elements: spiritual and environmental. Health becomes a state of balance characterized by physical, mental, social, spiritual, and environmental well-being. Implicit in this definition is a philosophy summarized by the saying “All my relations (or relatives).” Whether recited in English or in a Native language (e.g., “Mitakuye Oyasin” in Lakota), this phrase means that health is a state of connectedness in which stones, plants, animals, and people are recognized as family. A type of affirmation that may close a prayer, it is sometimes compared with the word Amen, but it means much more than that. Amen, which is Hebrew for “so be it,” implies assent or approval, whereas Mitakuye Oyasin may be translated as “We are all children of the Great Spirit. May my words, prayer, song, and ceremonial actions be for the harmony and good of all.”

“All my relations” is an expression of the recognition that family and community are essential elements of health. During precontact times, the health and survival of a tribe depended on each person doing his or her part to the best of his or her ability. Indulging in shame, self-pity, acting-out behaviors, social withdrawal, or extravagance and excess consumption were not personal matters. What today would be considered “group therapy” might occur during a meeting or council that included one or more wise elders. Confidentiality was not an issue. Today, the value and importance of community remain, but psychological or psychiatric problems and the need for therapy are perceived as social stigma and cause for embarrassment. Confidentiality is an important matter, and patients will sometimes avoid or delay allopathic treatment until they can visit therapists or clinics far away, where office workers or other patients are less likely to recognize them.

Traditional Healers

Many Native healing methods, such as herbal medicine, massage, and music, are similar to complementary and alternative medicine (CAM) therapies. Traditional North American Indian healers are often willing to share these methods with the public and with health care colleagues through lectures, courses, articles, books, and, more rarely, in collaborative research.⁵¹ However, it is important to understand that, when a technique is removed from its original context of culture, language, and geography, it may not be as effective. In addition, the Native American doctor is expected to “walk the talk” by being an example of Native values and actually believing in the reality of spiritual forces. It is not enough to imitate a method such as blending an herbal tea.

Native American healers may be specialists or have broad expertise. Among some tribes, there are separate terms for herbalists, bonesetters, midwives, diagnosticians, ceremonial experts, and people known for their gifts in massage, counseling, dreaming, or prayer. Some healers are recognized as holy people, whose direct contact with transcendent realms gives them the intuition, knowledge, and power to adapt or create methods that best fit the needs of their patients. These healers are popularly called medicine men, medicine women, or holy people. Fools Crow⁴⁹ (Lakota) and Flora Jones^5,41 (Wintu) are examples of well-respected 20th-century medicine people. None of the English language terms for indigenous healers are exact; they are often used indiscriminately in popular literature. A person described as a “medicine man” may be considered primarily an herbalist in his own tribe. An ethnographer may label a woman an “herbalist” who is in fact a medicine woman. In this chapter, I use the term “traditional healer” as a general category for all of the various types of indigenous North American healers. Traditional healers may be male or female and young or old, although I have not met a healer who is less than 35 years old—in fact, most are older than 50.

One becomes a traditional healer by any combination of an innate gift or talent; personal training, including ceremonial participation, vision seeking, fasting, or apprenticeship; and a ritual transfer of power from a previous healer. “Personal training”—although primarily experiential—may include learning from texts (e.g., healing chants and practices transcribed by the Cherokee in their own language)⁹ as well as from historic audio recordings and other media, including representations of healing practices in rock art or herbal remedies drawn on “pharmacopoeia sticks”⁵³ (Figure 108-1). “Apprenticeship” involves learning from the example, demonstration, mentorship, and wisdom shared by a teacher.

FIGURE 108-1 Nineteenth-century pharmacopoeia stick from the Museum of the Wisconsin Historical Society.

(Courtesy Daniel Moerman, used with permission.)

Any of the terms for traditional healers, especially medicine man/woman, are conferred by a community or group of Native people in recognition of years of wise and effective service. Although one may call oneself an “herbalist” or “traditional midwife,” it is rare and considered egotistical to call oneself a “medicine person.” I heard a Lakota medicine man say, “The only healer is the Great Spirit. I am only an interpreter.” Most of the traditional healers I have met have spent at least 7 to 10 years in rigorous training or apprenticeship before assuming their roles.

Elder

The term elder occurs frequently in literature and discussions about Native American culture. Although this word may, at times, refer to a person’s age, it more commonly means a keeper of ancient traditional wisdom. According to the website of the Canadian Council of Elders, in the Algonquin Nation, “an Elder is defined as someone who possesses spiritual leadership which is given by one’s cultural and traditional knowledge. This knowledge is found in the teachings and responsibilities associated with sacred entities such as the Pipe, Wampum [sacred shell beads] belt, Drum and Medicine people. In addition to the spiritual recognition given by the Creator and the Spirit World, an elder is given the title and recognition as elder by other elders of his/her respective community and nation. Also one does not have to be a senior citizen to be an elder.”¹ Various Indian Nations have their own definitions of the term elder, but the principles are similar. An elder passes along traditional values; he or she models, guides, and counsels people regarding how to live in a good way.

Etiology in a World of “All My Relations”

In an interconnected and interdependent universe, it is impossible to posit a distinct cause for any disease. An infectious agent requires a vulnerable host, and the degree of vulnerability is affected by many factors, including genetics, environment, emotions, cognitive habits, diet, exercise, timing, and previous health history. Native Americans accept this biomedical model but believe that illness and trauma may also have hidden precipitating causes. For example, was the climbing accident a result of lack of technical skill, simple carelessness, or perhaps not paying attention to warnings from the spirit world in the form of omens or dreams (Figure 108-2)? Ethical and spiritual transgressions (e.g., a breach of taboo), such as disrespectful behavior in or toward nature, may also cause misfortune.

FIGURE 108-2 The Oracle Rock, a place for divination and insight, Pipestone National Monument, Minnesota.

The powerful spirits of nature can be sources of curse or blessing. If one is in harmony with these spirits, even ordinarily dangerous or life-threatening events may cause little adverse effect. For example, a Cherokee medicine man deliberately entered a den of rattlesnakes and lived through 18 snakebites without medical treatment. This was a test issued by his mentor to see if the snake was indeed his helping spirit. If he lived, the answer was obvious. In another example, a young woman was stung multiple times by a box jellyfish that had wrapped around her leg. She suffered only a little discomfort, which she attributed to her connection with the local indigenous culture and the nature and ocean spirits. Conversely, I remember a striking example of how a person’s negative attitude can immediately affect health. While participating in a sweat lodge ritual in Saskatchewan, Canada, a Native man vented anger about one of the other participants. Such a display is considered taboo during a sweat, where there is a strong emphasis on the power of positive words. This man was the only one to suffer burns during the sweat, a phenomenon I had never before or since witnessed. (Although, as is mentioned later, even relatively safe therapies can become dangerous in the hands of unqualified practitioners.)

Considering common aspects of North American Indian culture, there are four general categories of pathogenesis: biomedical, environmental, psychological/psychosocial, and spiritual. Diseases may be caused by any combination of these factors.

Biomedical

The biomedical category includes all of the etiologic factors recognized by modern medicine. Native American healers are part of the modern world and accept the scientific method as an important tool in the human search for truth. I have yet to meet a medicine man who would not go to a physician for diabetes management or for the treatment of a bacterial infection. Diseases may certainly result from biochemical, metabolic, and mechanical imbalances; from viruses, bacteria, and parasites; from habits of posture and breathing; and from the influences of heredity and trauma. However, from the traditional healer’s perspective, these are causal influences and co-factors rather than final explanations for disease. As one of my Native colleagues astutely commented, “Even germs have spirits.” It is admirable that Western science can measure and predict the influence of microorganisms. On a psychological level, this satisfies the human need for certainty. However, for Native American healers, life falls outside the intellectual grid imposed by Western philosophies.

Environmental

When using the term environmental, I mean, very simply, that our connection with nature and nature’s cycles is a major influence on health and well-being. Other things being equal, people who spend more time outdoors in a natural setting are physically and psychologically healthier. Children today are missing the freeform and unstructured play that is the basis of creativity. “Where do you like to play?” a third grader from San Diego was asked. “Inside,” he replied, “because that’s where the electric outlets are.”⁴⁷ Children who play in nature are more resilient and better at reading and problem solving. Nature has measurable effects on the human organism. The earth’s magnetic field regulates biologic rhythms and gives humans, like homing pigeons, a sense of direction and orientation. Regular exposure to natural sunlight and evening darkness promotes optimal vitamin D and melatonin levels, the latter a requirement for restorative sleep and dreams.

Clean air and pure food and water allow us to be refreshed each day. This simple formula for health is becoming increasingly difficult to follow, as the United States Environmental Protection Agency warns of more than 3.8 billion pounds of toxic chemicals being released into the environment during a typical year.⁷⁵ In 2009, the Centers for Disease Control and Prevention’s Fourth National Report on Human Exposure to Environmental Chemicals measured 212 chemicals—including plastics, mercury, and arsenic—in blood and urine samples from 2400 U.S. citizens. Several industrial chemicals were found in nearly all participants, including polybrominated diphenyl ethers (fire retardants), bisphenol A (a component of epoxy resins), perfluorooctanoic acid (used in the manufacture of heat-resistant nonstick coatings in cookware), and the common gasoline additive methyl tert-butyl ether. Our health is also adversely affected by insecticides, herbicides, drugs, solvents, car and factory exhaust, electromagnetic fields, and ionizing radiation. There is clear evidence that toxic load is reaching a critical threshold after which further assaults result in increases in mortality and morbidity.¹⁴

Wilderness, say indigenous people, is healing. The degree of healing power or influence may also vary, with some places having more or less—hence the customs of pilgrimage to and vision seeking at sacred sites (Figure 108-3). To spend more time in healing places is to enhance one’s ability to resist and recover from disease. It is also the basis for recognizing healing herbs and connecting with their spirits, a necessity in Native herbal medicine.

FIGURE 108-3 Bear Butte, South Dakota, holy place for the Lakota and many other tribes. Note the colored flags (prayer offerings) hanging from trees in the foreground.

Psychological/Psychosocial

The Cherokee traditional healer Rolling Thunder used to admonish, “Pollution begins in the mind” (Figure 108-4). Indeed, the reciprocal influence of mind and body, the core of today’s psychoneuroimmunology, is well accepted in Native American medicine. “No evil sorcerer can do as much harm to you as you can do to yourself with negative thinking,” the Samish traditional healer Johnny Moses once shared with me. Counseling, dream interpretation, and psychodrama (particularly the acting out of nighttime dreams) were common indigenous treatment modalities.^18,78 A positive attitude goes a long way toward enhancing the efficacy of any therapy or making such therapy unnecessary. Traditional healers are often experts at inducing the placebo effect.

FIGURE 108-4 Rolling Thunder and the author, 1982.

As I tried to demonstrate in “At the Canyon’s Edge: Depression in American Indian Culture,” psychological and psychogenic diseases are of urgent concern to today’s Native Americans.¹⁷ Duran and Duran have written insightfully about the prevalence of intergenerational post-traumatic stress disorder, resulting from the tragic history of Native peoples, their marginalization, the continuing challenges of racism, and the lasting effects of boarding school abuses and domestic violence.²⁵ Some psychological problems are also the consequences of alcohol and drug abuse or birth defects, or associated with diseases such as diabetes and obesity. The breaking up of families and communities means that Native people now face problems on their own that would previously have been addressed by the group. Alienation and loneliness have replaced accountability and security. The programs most successful at treating psychological problems are integrative in nature, combining Western and indigenous therapies.^28,69

In Native American medicine, major psychological influences on disease include sense of life purpose, degree of self-esteem, cognitive habits, and familial and social harmony.

Of these four, the first merits commentary. Native Americans believe that every person has a life purpose. To live a good life, one must prioritize discovering that purpose. This philosophy explains why dreams, and dream- or vision-quests, are so important in Native American culture. Equally important is to find the courage to live and express this purpose. A purpose not lived or a gift or talent that is kept locked up inside because of fear of failure, worry about disappointing others, and lack of self-esteem, is like stagnant water—a breeding ground for disease. We may become ill from our unlived dreams just as we may heal by the dreams we live. To find and live one’s purpose is to tell, with one’s life, a good story. Many people lose joy in life or make and remake bad choices because they repeat to themselves a bad story. By contrast, good stories create meaning and purpose.

In 2004, I had the honor of presenting a talk about indigenous medicine to the Cree elders advisory council associated with a First Nations health center in Canada. As I was preparing, my adoptive Cree brother, Joseph, reminded me, “The elders will not listen if you give them information. They will pay attention if you present the information in the form of storytelling.” One of the goals of the traditional healer is to hear and sense, often through intuition, the stories patients tell themselves, and then to help them “write” a better one. In counseling, raw information rarely heals.

Spiritual

The term spiritual refers to the causes of illness that concern or originate in the spirit, soul, or transcendent realms. Unlike with popular Christianity, in Native American philosophy, spirit and soul may be attributes of stones, plants, and animals, not just people. Emotions are also spirits. Traditional Cree healers in Saskatchewan say that the spirits of hatred or shame may cause disease, just as the spirits of love and forgiveness can heal. However, spirit is not opposed to flesh. Aspects of the soul may be linked with the breath of life (niya in Lakota) or with the spirit or ghost that exists after the death of the body (nagi in Lakota). Spirit is also an innate protecting force as well as a sacred power that may be gained by a person through sacrifice and contact with the divine (sicun in Lakota).²³ My Cree relatives distinguish between the appearance of the soul as a “ghost” (tchi-pay) while it remains on Earth and the soul (at’-tshak) that journeys to the spirit world.²⁶ The latter term, at’-tshak, is the root of the word for “star,” which is at’-tshakos. The stars are the spirits of those who have passed on, and the trail they walk is the Milky Way. We can see that not only are spirit and matter not separate, but that the spiritual realm interpenetrates the ordinary. People can contact this other reality through prayer, ceremony, and waking or sleeping dreams.

Diseases always have a spiritual dimension. We are whole human beings, never divided, no matter how isolated parts look in a scan or under the microscope. In other words, whether the presenting symptoms suggest a predominantly biochemical, environmental, or psychosocial origin, a traditional healer also pays attention to spirit.

A person who is disconnected from his or her own soul or from the Great Spirit is only living a partial life and is more likely to become ill. Dreams are the royal road not only to the unconscious but also to the spirit world, and traffic goes both ways. In dreams, we contact spiritual realms, and these realms reach down to contact us. An effort to remember and interpret one’s dreams by looking for clues to health and prevention of illness or misfortune is necessary for optimal health. Sometimes the traditional healer helps an unaware patient by searching for relevant information, both diagnostic and therapeutic, in the patient’s dreams, or teaches methods to help the patient have and recall more meaningful dreams.

Contact with spirits may help prevent disease, but it can also cause disease. There is an ancient legend among the Cherokee and other Southeastern tribes that the spirits of animals caused disease as retribution for disrespectful hunting practices that today would be called “trophy hunting.”⁵⁴ Illness results when people insult or mistreat animals, invade or destroy their habitat, or fail to show respect to animals while hunting or eating them. In Crossing into Medicine Country, Choctaw author David Carson associates specific illnesses with various animals.¹³ If a person knows this connection, he or she may be able to relieve symptoms or cure disease by honoring the animal (e.g., with a feast among friends that is specifically intended to honor the animal) or by asking forgiveness from the offended animal spirit. As a sign of reconciliation, the animal may heal the illness directly or appear in a dream to offer advice.

Most of these animal–disease associations make good sense. For example, according to Carson’s book, the millipede causes aching legs and lack of coordination. The moose may cause self-hatred, manifested as chain smoking, overeating, or destroying relationships without reason. Dog sickness is characterized by fever and delirium. Coyote sickness appears as obsession and addiction, including alcohol, drug, and sex addiction. It is no surprise that beavers may inflict constipation; one feels dammed up. Squirrels eat too much or too little. Turkeys swell with pride and may cause false pride, repressed anger, swollen glands, and cancer.

Spirits may be capricious, mischievous, or malevolent. For this reason, elders advise not contacting the realm of spirits unless one is in need, emotionally mature, or prepared and aided by a traditional healer. Sorcerers, popularly called witches by some Native tribes (although they are not to be confused with Western pagan Wicca traditions), can inflict harm by sending disease-causing spirits to their victims. Although many, if not most, of these phenomena are probably examples of the nocebo effect, my personal opinion is that negative intent can have concrete effects even if the victim does not believe in or is unaware of the “curse.” Sorcerers may be hired by people to inflict harm and misfortune on other people, or they may be personally motivated to perform such criminal activities as a result of emotional imbalance (most commonly jealousy).^24,77

There is also a traditional and widely held Native philosophy that negative actions eventually return to plague the perpetrator. Rolling Thunder taught that good deeds and bad deeds are both multiplied by seven to help or harm the person who performs them.¹¹ Tuscarora traditional healer Ted Williams used to say that life is governed by natural and moral laws.⁸¹