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Intro & Cause of Mental Illnesses

In 1955 the Indian Health Service (IHS) was created to ensure efficient health care of Native Americans.  It was and still is believed that the United States has an obligation to care for the health needs of Native Americans because of their misplacement, harsh treatment, and disruption of their culture.  The acts that were committed against Native Americans by colonist and later the United States, left many Native American tribes in vulnerable and weak state.   This weakened state was thought to be aided by the IHS (Grandbois, 2005).  However, the goals of the IHS have not been met and many disparities have befallen Native Americans.  Of all the disparities that Native Americans face mental health care maybe the greatest.  The article “Stigma of Mental Illnesses Among American Indian and Alaska Native Nations: Historical and Contemporary Perspectives” addresses these concerns in detail and what must be done to help improve the quality of life among Native Americans (Grandbois, 2005).

The article focuses on some of the things that have led to the negative health factors of American Indians and Alaska Natives (AIAN), stigma that comes from mental illness, negative domains that effect AIAN lifestyles,  and what must be done to improve AIAN health conditions (Grandbois, 2005).

When colonist came to America they did more than just relocate AIAN’s.  They also brought several diseases, such as cholera, malaria, small pox, & the bubonic plague (Grandbois, 2005).  Prior to the colonists coming to America, Native Americans had experienced few serious diseases and were very susceptible to diseases that colonists carried since Native Americans had never encountered these diseases.  Due to these diseases, relocation and small conflicts over half of the Native Americans in the United States died in the 19th century (by comparison to before colonists had arrived) (Grandbois, 2005).

After the rights and culture of AIAN’s were violated they received many promises and treaties that were thought to help their people.  However, the majority of these promises were broken and some were not meant to help them at all.   These broken promises have caused a sense of mistrust between natives and the government.  Lack of trust, as well of a lack of cultural understanding on the western side, has caused issues in diagnosing, understanding symptoms and treating natives much more difficult (Grandbois, 2005).

Various tribes have different view points on mental illnesses.  Before colonists came to America, the natives that were already residing there did not have any understand of a mental illness.  AIAN’s viewed all illnesses as bodily illnesses (Grandbois, 2005).   This means that the concept and stigma that exists in AIAN cultures came originated from western influence.  There are two processes that occurred within tribes that affected the way that these tribes viewed mental illnesses and the stigma that comes with the illness.  Deculturation is the process in which a group loses their original culture and reculturation of adapting the culture of the majority (Levy & Shiraev, 2009).

The stigma that results from a mental illness is not only in AIAN cultures, stigmas can cause an individual to avoid treatment which can prolong and worsen an illness.  Stigma about mental illness can cross-cultures and can be considered etic because it is not designated to a particular culture (Levy & Shiraev, 2009).  It may also be considered emic because not all tribes have adapted the same view of mental illnesses and different stigmas may be applied depending on the illness (Levy & Shiraev, 2009).  The amount of stigma that a tribe ascribes to mental illnesses normally correlates to the amount of deculturation and reculturation that occurs within the tribe.  The higher deculturation and reculturation the higher the stigma and the more assimilated these tribes have become to the dominant culture (Levy & Shiraev, 2009) (Grandbois, 2005).

Common Mental Illnesses in American Indian Cultures

There are several key mental illnesses that seem to run rampant in AI(American Indian) communities, they include, major depression, alcohol abuse, and anxiety disorder (Duran et al., 2004) (Haller & Aitken, 1992).   Some of these mental illnesses may also lead to suicide, which is also prevalent in AI communities (Haller & Aitken, 1992).   A study that correlated the relationship between alcohol consumption and suicide in AI’s, living in New Mexico, they found that an large amount of AI’s had alcohol when prior to committing suicide (69%) (May, Van Winkle, & Williams, 2002).  Of the general population in New Mexico who committed suicide only 44% had alcohol prior to suicide (May, Van Winkle & Williams, 2002).  These statistics demonstrate how a substance abuse may lead to other unhealthy behavior and certainly other mental illness could lead someone to consume alcohol.  Another study also found that religion was not a key issue of suicide in AI’s (Garroutte, Goldberg, & Beals, 2003).  In the study both natives with traditional beliefs and Christian beliefs were compared and it was found that the only factor that contributed to suicide rate was the amount of commitment to their religion, those who were more committed were less likely to attempt suicide(Garroutte, Goldberg, & Beals, 2003).

There are also other health disorders that afflict AI such as, obesity, diabetes, & cardiovascular disease (Haller & Aitken, 1992).   One commonality that I see between all of these diseases is that they can all be negatively influence by stress and unhealthy, or uncertain, living conditions that usually increase level of stress.  Metabolic disorders, such as diabetes or obesity, may be considered a by-product of western influence (Haller & Aitken, 1992)(Berk,2007).  Before westerners came to America the natives here had their own diet and eating habits.  When AI’s were forced into reservations or out of their homes they were prevented from following herds and cultivating the land as they normally would, forcing them to change their diets.  It has been shown that when indigenous cultures change their diets to those of another culture that health issues may occur (Berk,2007).

A recent article looked at females among the AIAN groups and compared mental illnesses among them to sociodemographic factors.  Their findings showed female AIAN’s had a higher rate of depression, anxiety and substance related disorders, by comparison to non-AIAN females (Duran et al., 2004).  Figure 1.3 has a link and will show statistics that their study found.

Fig 1.3 -----Non-AI and AI stats

These findings have been supported elsewhere as well (Mental Health: Culture, Race, Ethnicity – Fact Sheets).  However, in both studies the sample sizes were relatively small.  Also, each comparison of mental illnesses was between AIAN’s and the general population (Duran et al., 2004).  I think that if they compared AIAN communities to other low-income communities (of a similar sample size) around the U.S. that anxiety and substance abuse disorders would have seemed similar.   Another article that took in account other urban neighborhoods, as well as AIAN communities, found that healthcare was lacking broadly across multiple low-economic communities and it acknowledged that broad actions must be taken to engage disparities in healthcare (Castor et al., 2006).

Symptoms & Prevention

Symptoms & Prevention

Although it was difficult to find research on the differences in the way AIAN’s(American Indian/Alaskan Native) describe their mental disorder symptoms compared to others in the United States.  Typically collectivistic cultures describe their symptoms by emphasizing the way that their body feels physically as a opposed to their emotions and cognitive state, found in individualistic cultures (Levy & Shiraev, 2009).

It was also challenging to find information on how to directly prevent mental illnesses for AI’s(American Indian).  AI’s may face a varied set of obstacles that lead to mental illness you could insinuate that if these obstacles were eliminated, the chance of acquiring a mental illness may lessen as well.  Some of the challenges that AI’s face include living below the poverty limit, poor education (prevent accessibility to high paying jobs) & limited access to health care (Grandbois, 2005).


Some steps have already been taken in the right direction to help spread understanding of Native American culture.  A workshop, on AI’s (American Indian), and a follow-up data analysis of the effectiveness of the workshop was conducted recently (Mays et al., 2009). Participants were selected based on the likelihood that they would at one point need to utilize the inform

ation that was given in workshop in their line of work. Some participants were instructors at universities or were in some other position where they may discuss American Indian’s (Mays et al., 2009). The workshop consisted of giving the participants information about the mental disparities of AI’s, offering strategies for addressing stereotypes, developing knowledge of common disorders among AI’s as they relate to the DSM-IV, diagnosing, managing and treating AI’s among many other topics. The results showed that the majority of participants found the workshop useful and informative (Mays et al., 2009).

I feel that workshops like this are necessary to increase awareness about the needs of AI’s.  I do think that some of the information from the surveys after the workshop maybe slightly bias (Mays et al., 2009).  I do not think that people in professions that should care about the mental health of AI’s will be inclined to speak their mind if they did not find the information useful, additionally if mental health of AI’s  is a concern of their profession then they should have probably known a fair amount about AI’s before they began the workshop (Mays et al., 2009).

The only other criticism that I have, although focusing on educating individuals in the mental health profession maybe a great idea, I do think that it would be best to find AI’s that are in the mental health field to be further trained to treat other AI’s.  I think that AI’s that are in the mental health field would more readily recognize the mental health disparities that their people are facing and would have a instinctive motivation to help his or her own people (Mays et al., 2009) (Gone, 2004).  Also, an AI would have an easier time recognizing and understanding how symptoms appear with in AI’s, assuming that the symptoms for the given mental illness is  emic,  as well as having a stronger grasp on AI culture (Levy & Shiraev, 2009).   AI’s that are treating their own people may be susceptible to group-serving bias, but I think that the large amount of disparities that are present within the AI group would negate group-serving bias (Levy & Shiraev, 2009).  Group-serving bias is when a group member is in a position to criticize or judge a person from their in-group and as a result of their position in their in-group they do not make fair judgments of that individual (Levy & Shiraev, 2009).

A article by Joseph P. Gone noted that steps are being taken in the right direction by getting AI’s trained in the mental health profession.  However, it appears that even though AI’s are capable of treating other American Indians there is still a unforeseen obstacle.  Gone interviewed a tribal leader (Fig. 1.2 ) and found that AI’s viewed receiving psychological treatment as erasing their history.  Receiving treatment for therapy could become stigmatized within the AI community as being untrue to yourself and becoming what the Whiteman wanted you to become (Gone,2004).  I think that this could become a major issue in treating AI’s but hopefully with time, effort and individuals seeing results from Western therapy, treatment for mental illnesses will become more acceptable within the AI community (Gone, 2004).

Fig 1.2

I think that the major problems in Native American health stem from lack of funding and failed promises of the United States.  Our government is not only supposed to supply adequate health care, but I feel that they should also be accountable for making sure that AIAN’s(American Indians/Alaskan Natives) have adequate education and job opportunities (Grandbois, 2005).  If AIAN’s had a better education and better jobs then they may be able to uplift their families and communities.  It is also known that high poverty levels can lead to more stress, poorer mental health and more general health issues.  More educated AIAN’s could help their people in many ways, such as helping change policies affecting their people, drawing attention to the government’s inability to fulfill their promises and AIAN’s with degrees in the mental health field could discover vital information in diagnosing/treating mental illnesses within AIAN tribes (Grandbois, 2005).

The article recommended that every federal branc

h that is involved or could contribute to the betterment of AIAN’s to take action.  It also mentioned that as Americans we should all feel responsible and take action towards the betterment of AIAN’s (Grandbois, 2005).  I think that to a degree this is true, but there are many more issues, that maybe as important, that citizens and politicians are focused on.  It would be foolish to really expect the focus of the United States to switch towards helping AIAN’s, although it is definitely something that should be done (Grandbois, 2005).

Natives view illnesses more of an imbalance and focus on curing the person, rather than focusing on the disease or illness.  Figure 1.1 has a video that goes into greater detail about the native perspective of mental illnesses (Mehl-Madrona, 2010).

Figure 1.1

Some common treatment methods that are used by IHS (Indian Health Service) and tribes include ceremonial dances, rituals, and chants.  I was shocked when I read that these are typical treatment methods that are used by IHS.  I would have assumed that if these are the treatment methods that AI’s use to treat their illnesses than they would be able to treat themselves, via a tribal leader.  However, I could understand that many of their traditions and practices may have been lost and tribal leaders may be sparse (Alternative Approaches to Mental Health Care, National Mental Health Information Center, 2010).

Alternative Approaches to Mental Health Care, National Mental Health Information Center. Mental illness, mental health information center. National Mental Health Information Center, n.d. Web. 14 May 2010.

Berk, L. E. (2007). Infants and Children: Prenatal Through Middle Childhood (6th Edition) (MyDevelopmentLab Series) (6 ed.). Boston, MA: Allyn & Bacon.

Castor, M., Smyser, M., Taualii, M., Park, A., Lawson, S., & Forquera, R. (2006). A Nationwide Population-Based Study Identifying Health Disparities Between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties. American Journal of Public Health, 96(8), 1478-1484. Retrieved from Health Source: Nursing/Academic Edition database.

Duran, B., Sanders, M., Skipper, B., Waitzkin, H., Malcoe, L., Paine, S., et al. (2004). Prevalence and Correlates of Mental Disorders Among Native American Women in Primary Care. American Journal of Public Health, 94(1), 71-77. Retrieved from Health Source: Nursing/Academic Edition database.

Garroutte, E., Goldberg, J., & Beals, J. (2003). Spirituality and attempted suicide among American Indians. Social Science & Medicine, 56(7), 1571-1579. Retrieved from Social Sciences Abstracts (H.W. Wilson) database.

Gone, J. (2004). Mental Health Services for Native Americans in the 21st Century United States. Professional Psychology: Research and Practice, 35(1), 10-18. doi:10.1037/0735-7028.35.1.10.

Grandbois, D. (2005). Stigma of mental illness among American Indian and Alaska Native nations: Historical and contemporary perspectives. Issues in Mental Health Nursing, 26(10), 1001-1024. doi:10.1080/01612840500280661.
Haller, E., & Aitken, L. (1992). Mashkiki: Old medicine nourishing the new. Lanham, MD England: University Press of America. Retrieved from PsycINFO database.

Levy, D., & Shiraev, E. (2009). Cross-Cultural Psychology (4th Edition) (4 ed.). Boston, MA: Allyn & Bacon.
May, P., Van Winkle, N., & Williams, M. (2002). Alcohol and Suicide Death Among American Indians of New Mexico: 1980-1998. Suicide and Life-Threatening Behavior, 32(3), 240-255. Retrieved from Social Sciences Abstracts (H.W. Wilson) database.

Mays, V., Gallardo, M., Gooden, K., Zanartu, C., Smith, M., McClure, F., Puri, S., Methot, L., & Ahhaitty, G. (2009). Expanding the Circle: Decreasing American Indian Mental Health Disparities through Culturally Competent Teaching about American Indian Mental Health. American Indian Culture and Research Journal. Volume 33, Number 3 / 2009 , 61-83.

Mehl-Madrona, L. (2010, March 22). YouTube- Lakota Concept of Mental Health and Illness.avi. YouTube – Broadcast Yourself. Retrieved May 14, 2010, from

Mental Health: Culture, Race, Ethnicity – Fact Sheets. (n.d.). mental illness, mental health information center. Retrieved May 14, 2010, from