Over the second half of last week I had the opportunity to observe several Telehealth clinics. The Telehealth clinics I’m observing provide remote mental health care (therapy sessions, medication check-ins, psychiatry appointments, etc.) over video chat to rural and Native American populations in several different states. One of the clinics I observed served patients in Nevada, and the other two served populations in my home state of New Mexico. Each day I learned something new and different, and seeing the different patients’ difficulties, while sometimes hard to see, was really educational and opened my eyes to a lot of issues, especially those experienced disproportionately by Native American communities.
On the second day of observing Telehealth clinics, I had the fortune to meet Maria Yellow Horse Brave Heart, a nationally known Native American scholar and expert on historical trauma. Despite her very busy schedule, she responded to the email I sent her and was kind enough to send me a few articles about historical trauma (HT).
What I learned made me very upset.
Now, as a privileged White person who has never experienced any oppression, I am lucky that I don’t have to know about historical trauma. I have never experienced the effects of historical trauma. I get to learn about it from an outsider’s point of view and don’t have to perform any emotional labor when I learn about it. Still, it made me so angry. But before I get too fired up about genocide and the lasting injustices in today’s society, here’s a little bit about historical trauma and its effects.
The article “Historical Trauma Among Indigenous Peoples of the Americas: Concepts, Research, and Clinical Considerations” by Maria Yellow Horse Brave Heart, Josephine Chase, et al, defines historical trauma as “…cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma.” Historical Trauma Response (HTR) is the psychological and behavioral response of someone who is affected by historical trauma. Some visible and related effects of HT on American Indian and Alaskan Native (AI/AN) populations include the following:
· AI/AN populations rank higher for health disparity than any other ethnic/racial minority in the United States
· Alcohol related deaths are 5 times more likely for Native Americans than for white people
· Suicide rates among AI/AN groups are 50% higher than the national average
· AI/AN communities experience heightened depression rates, PTSD, interpersonal loss, unresolved grief, alcoholism and other forms of substance abuse, lower life expectancy, and so on.
A huge component of historical trauma is the lasting and detrimental legacy of Native American boarding schools (also called Indian Residential Schools). Boarding schools removed Native American children forcibly from their communities and placed them in boarding schools with the goal of assimilating them into Euro-American culture, in the process erasing their culture, punishing them for speaking their indigenous languages and forcing them to wear traditional European dress. The schools were supposed to “Christianize” and “civilize” these children, and were hubs of sexual, physical, and emotional abuse. Given the absolutely horrific nature of these schools, it’s not surprising that there are lasting intergenerational effects in families that were exposed to these schools. Children who attended these schools were removed from their families, developmentally compromised, didn’t develop nurturing and discipline skills, and forced assimilation of European ideals erased traditional cultural gender roles for several generations. Parents who went to boarding schools and had harsh parenting at home report lasting difficulty with trust, forming and maintaining relationships, parenting, and communication. The compounding effect here is staggering.
To make matters worse, many indigenous cultural practices, including death rituals and grief resolution ceremonies, were illegal from 1883-1978 (!!!) until the passage of the American Indian Religious Freedom Act. Some traditional burial rituals are STILL outlawed today.
So, obviously, there is so much trauma in Native American communities. The good news is that culturally appropriate interventions like the Historical Trauma and Unresolved Grief Intervention are effective at treating and lessening some of the effects of historical trauma and are ideal because they can be tailored to the traditions and values of different tribal groups.
And yet.
I am upset and frustrated with myself that I didn’t think about historical trauma before. I know about genocide. I know about colonization. I grew up in a state with a particularly heavy and devastating colonial history. And yet, because I am White, I have the privilege of only having to think about the lasting legacy of genocide when I want to.
Learning about historical trauma from an intellectual standpoint is one thing. Observing its very real effects in the Telehealth clinics thus far is another thing entirely. Observing very real people talk about their trauma and their difficult lives has been a very needed and helpful reminder of my privilege and how important culturally informed treatment is. As someone who wants to become a clinical psychologist one day, I’m thankful to have had the opportunity to observe these Telehealth clinics because before this experience, I never thought about how important a culturally informed approach to mental health care treatment is. I was naïve. I had the privilege to be. But now that I’ve started to learn about historical trauma and other important factors in a patient’s life, I am even more motivated to learn about the intersections of psychology and identity. This is only the beginning.