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Transgenerational Transmission of Historical Trauma The diagram depicts some of the hypothetical pathways through which the effects of trauma and loss may be transmitted across generations through processes at multiple levels, including: epigenetic alterations of stress response; changes in individuals' psychological well-being, self-esteem, and self-efficacy; family functioning; community integrity and cultural identity; and the continuity of identity and collective efficacy of whole nations or peoples. (Adapted from Kirmayer et al., 2007). 

Transgenerational Transmission of Historical Trauma The diagram depicts some of the hypothetical pathways through which the effects of trauma and loss may be transmitted across generations through processes at multiple levels, including: epigenetic alterations of stress response; changes in individuals' psychological well-being, self-esteem, and self-efficacy; family functioning; community integrity and cultural identity; and the continuity of identity and collective efficacy of whole nations or peoples. (Adapted from Kirmayer et al., 2007). 

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Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of di...

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... potential pathways are complex. As outlined in Figure 1, intergenerational transmission may occur at many levels, including: interpersonally, through altered parenting; within families, which may be disrupted by loss of members or exposure to stressors like domestic violence; at the level of the community, when many Transcultural Psychiatry 51 (3) individuals and families are impacted by disturbances of social networks and experiences of safety and solidarity that affect health; and at the level of nation, where the suppression of culture and the disruption of family and community threaten the continuity of whole peoples. Additionally, recent work identifying epigenetic processes in stress and trauma transmission point toward biological levels (McGowan, et al., 2009). Although proponents of historical trauma have been quick to seize on this postulated mechanism of transmission ( Walters et al., 2011), the temptation to participate in fashionable forms of biological reductionism (Kirmayer & Gold, 2012) may not serve the emancipatory goals of Indigenous decolonization (Prussing, 2014). Moreover, there is no reason to assume that epi- genetic mechanisms-which appear to be reversible with appropriate life experi- ences-would not operate in service to intergenerational resilience as much as to intergenerational trauma. Finally, while postulated biological mechanisms are The diagram depicts some of the hypothetical pathways through which the effects of trauma and loss may be transmitted across generations through processes at multiple levels, including: epi- genetic alterations of stress response; changes in individuals' psychological well-being, self-esteem, and self-efficacy; family functioning; community integrity and cultural identity; and the continuity of identity and collective efficacy of whole nations or peoples. (Adapted from ...

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... Postcolonial distress (ie, contemporary trauma embedded in Western culture and systems 37 ) and chronic stressors (eg, poverty, food insecurity) affect SDH across the lifespan and can be understood by the most salient culprits (ie, racism, discrimination) and symptom (ie, SUDs). 38 Moreover, systemic racism has been linked to health disparities, barriers to SDH (eg, medical care, education, food, clean water), SUDs, and diseases (eg, ADRD). 39,40 Ecological Systems and Alaska Native Worldview Bronfenbrenner's 41 ecological systems theory is an appropriate framework for understanding how historical traumas, postcolonial distress, and symptomatology (eg, SUDs) are interrelated, cumulative, and compounding across the lifespan. ...
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Background American Indian and Alaska Native (AI/AN) peoples are disproportionately impacted by substance use disorders (SUDs) and health consequences in contrast to all racial/ethnic groups in the United States. This is alarming that AI/AN peoples experience significant health disparities and disease burden that are exacerbated by settler-colonial traumas expressed through prejudice, stigma, discrimination, and systemic and structural inequities. One such compounding disease for AI/AN peoples that is expected to increase but little is known is Alzheimer's disease and related dementias (ADRD). AI/AN approaches for understanding and treating disease have long been rooted in culture, context, and worldview. Thus, culturally based prevention, service, and caregiving are critical to optimal outcomes, and investigating cultural beliefs regarding ADRD can provide insights into linkages of chronic stressors, disease, prevention and treatment, and the role of substance misuse. Method To understand the cultural practices and values that compose AI/AN Elder beliefs and perceptions of ADRD, a grounded theory, qualitative study was conducted. Twelve semistructured interviews with AI/AN Elders (M age = 73; female = 8, male = 4) assessed the etiology, course, treatment, caregiving, and the culturally derived meanings of ADRD, which provides a frame of understanding social determinants of health (SDH; eg, healthcare equity, community context) and impacts (eg, historical trauma, substance misuse) across the lifespan. Results Qualitative analyses specific to disease etiology, barriers to treatment, and SDH revealed 6 interrelated and nested subthemes elucidating both the resilience and the chronic stressors and barriers faced by AI/AN peoples that directly impact prevention, disease progression, and related services: (1) postcolonial distress; (2) substance misuse; (3) distrust of Western medicine; (4) structural inequities; (5) walking in two worlds; and (6) decolonizing and indigenizing medicine. Conclusion Barriers to optimal wellbeing and SDH for AI/AN peoples are understood through SUDs, ADRD, and compounding symptoms upheld by colonial traumas and postcolonial distress. En masse historical and contemporary discrimination and stress, particularly within Western medicine, both contextualizes the present and points to the ways in which the strengths, wisdom, and balance inherent in AI/AN culture are imperative to the holistic health and healing of AI/AN peoples, families, and communities.
... this results in what may be seen as overstatement or even caricature. For example, her accounts of transgenerational transmission of colonial trauma and of psychosomatic causation of somatic symptoms are problematic insofar as they focus on single strands in multilevel causal pathways that are mediated in part by our own self-understanding (Kirmayer, Gone, & Moses, 2014;Kirmayer & Gómez-Carrillo, 2019). Collective memory, narrative and counter-narrative are not simply windows onto underlying physiological or social processes but sites of contestation that are constitutive of the links between history, identity and affliction (Kirmayer, 2014b). ...
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In an essay in PPP, Emily Walsh explores the significance of memory for coming to grips with the enduring legacy of colonialism in psychiatry. She argues that “for reasons of self-preservation, racialized individuals should reject collective memories underwritten by colonialism.” Psychiatry can enable this process or collude with the structures of domination to silence and disable those who bear the brunt of the colonialist history of violence and its current global incarnations. In this brief commentary, I underscore the importance of Walsh’s argument, link it to contemporary work in cognitive and social science on the dynamics of memory, and point to some resources for implementing these insights in health services and clinical practice.
... 53,54 The relationship of marginalization and multigenerational transmission of trauma has been well-documented among African American, Indigenous, and other communities of color. [55][56][57][58] Vigil and Moore 59 coined the term "multiple marginality" to; explain the intersection of social and economic forces faced by some low-income youth of color, manifested in "inadequate living conditions, stressful personal and family changes, and racism and cultural repression in schools." [59][60][61] Histories of trauma and runaway were present in case files of over 90% of youth incarcerated in Hawai'i. ...
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... As such, the stress and trauma experienced by Aboriginal Australians due to colonisation are not restricted to the first Aboriginal generations but persist throughout subsequent generations in a process named "intergenerational trauma" [4,5]. Intergenerational trauma occurs due to the collective experience of colonial injuries experienced by Aboriginal populations, whose identity, culture, ways of life and interactions were radically altered, and its cumulative effects on individuals from contemporary generations [6,7] (for an in-depth discussion on the transmission mechanisms of intergenerational trauma, please refer to Kirmayer, et al. [7]). Research has shown that the disruption of the social fabric of Aboriginal societies has brought contemporary Aboriginal peoples long-term psychological 2 of 21 sequelae, such as a higher lifetime risk of depression or suicidality [8], physiological distress [9], and death from suicide compared to their non-Aboriginal counterparts [8,10]. ...
... As such, the stress and trauma experienced by Aboriginal Australians due to colonisation are not restricted to the first Aboriginal generations but persist throughout subsequent generations in a process named "intergenerational trauma" [4,5]. Intergenerational trauma occurs due to the collective experience of colonial injuries experienced by Aboriginal populations, whose identity, culture, ways of life and interactions were radically altered, and its cumulative effects on individuals from contemporary generations [6,7] (for an in-depth discussion on the transmission mechanisms of intergenerational trauma, please refer to Kirmayer, et al. [7]). Research has shown that the disruption of the social fabric of Aboriginal societies has brought contemporary Aboriginal peoples long-term psychological 2 of 21 sequelae, such as a higher lifetime risk of depression or suicidality [8], physiological distress [9], and death from suicide compared to their non-Aboriginal counterparts [8,10]. ...
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... Knowledge of family and community history can help youth understand where they fit in this cultural disruption and repair process (Fryberg, Covarrubias, & Burack, 2013). Knowledge of the real history can shift the gaze off individual struggles to the need for a community level response (Evans- Campbell, 2008;Kirmayer, Gone, & Moses, 2014;Schultz, Cattaneo, et al., 2016;Wexler, 2009). Truth can help people move past anger and fear and shift to love and determination. ...
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... AI children were forced into boarding schools (Kirmayer et al., 2014;Ross, 2016) to control their social, academic, cultural, and physical development (Brayboy & Lomawaima, 2018;Reyhner & Eder, 2017). The architects of boarding schools punished AI children for speaking their traditional languages (Kimmerer, 2013;Running Bear et al., 2018) and denied them opportunities to participate in their cultural or spiritual practices (Clark & Wylie, 2021). ...
... The transfer of intergenerational trauma for AIs is related to historical trauma (Brave Heart et al., 2011;Mohatt et al., 2014;Sotero, 2006;Wexler & Gone, 2012) or the Soul Wound (Duran & Duran, 1995). Historical trauma is the collective experiences shared by generations of AIs (Brave Heart et al., 2011;Mohatt et al., 2014) who faced intentional acts of colonization (Brayboy, 2005;Crawford, 2014;Gone, 2013;Kirmayer et al., 2014). Scholars indicate that the shared cultural-related historical trauma experienced by AIs may contribute to Bear et al., 2018;Wexler, 2006). ...
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This article presents findings captured during a study with four Non-Indigenous child and adolescent psychiatrists treating American Indian youths at a child and adolescent psychiatry hospital located in a rural northwestern state. The author used a qualitative design to develop a deeper understanding of how the psychiatrists conceptualize the relationships between the components of school connectedness and American Indian youths. The study resulted in categorizing 53 descriptors of protective factors and 31 descriptors of risk factors associated with elements of school connectedness identified as 1) Cultural Connectedness, 2) Community, 3) Caregivers, 4) Teachers, and 5) Peers. The descriptors are illustrated through richly detailed comments from the participants.
... Historical trauma is a social determinant of health, defined as the residual physical, emotional, and psychological effects of intergenerational injury. 31 As opposed to individual posttraumatic stress, historical trauma is "adverse shared historical experiences". 32 The term was meant to be distinguished from individual posttraumatic stress or Adverse Childhood Experiences, representing collective trauma, such as slavery, colonization, and forced migration. ...
... Despite its focus on a collective experience of trauma, historical trauma can paradoxically individualize trauma, focusing attention on individual healing rather than the structural oppression that causes and maintains the trauma (Kirmayer et al., 2014;Maxwell, 2014). The original concept of historical trauma was based on the model of posttraumatic stress disorder (PTSD) and thus framed historical trauma as a clinical syndrome that could be treated through culturally adapted psychotherapy (Brave Heart et al., 2011). ...
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Little is known about how Asian American families, as well as other racially marginalized families, communicate about ethnic and racial group histories, particularly regarding historical trauma. Unlike personal trauma, historical trauma refers to distressing or life-threatening events which members of a group with a shared social identity experience together and pass on to their descendants. It has been studied in a variety of groups and contexts, notably in Holocaust survivors and their families and in Native American communities. The concept has seen limited application to Asian American groups, despite its relevance to their unique and shared lived experiences. For instance, the majority of Asian Americans have immigrated from countries across Asia that have been profoundly affected by war and political upheaval in the past century. Research on historical trauma among Asian Americans has focused primarily on refugees who fled the US wars in Southeast Asia, with some research on Japanese Americans who were incarcerated during World War II. Historical trauma related to other major events, such as the India/Pakistan Partition, the Chinese Civil War and Cultural Revolution, the Korean War, and the Sri Lankan Civil War, have not been examined among Asian Americans. A lack of recognition of these historical traumas within families and communities, as well as in the psychological literature, may mask important pre-migration history effects on Asian American families across generations. In this paper, we consider how historical trauma impacts Asian American individuals, families, and communities. We also examine the role of intergenerational communication in historical trauma and in Asian American families and communities. Finally, we discuss historical trauma among Asian Americans within the framework of radical healing, particularly how intergenerational communication about historical trauma can raise critical consciousness, facilitate ethnic-racial identity development, and reinforce ethnic-racial socialization.
... Furthermore, PCATs for Indigenous peoples should abstain from making Pan-Indigenous assumptions but rather give space to respect diversity within Indigenous groups. Given that complexity among Indigenous patients arises from the traumatic inter-generational and multi-level impacts of colonization and can manifest itself through several various different pathways [78], it is important that questions are framed in a manner that seeks permission before exploring social realities, for example asking "is it okay if we talk about your living conditions?" allowing the patient to control the depth of information they feel comfortable disclosing. PCATs to date are conceptualized from Western ideologies in that they locate the complexity at the individual level and approach complexity from a deficitnarrative [79]. ...
... PCATs to date are conceptualized from Western ideologies in that they locate the complexity at the individual level and approach complexity from a deficitnarrative [79]. PCATs for Indigenous patients should identify how social injustices rooted in a colonial legacy have shaped the health outcomes of Indigenous peoples while not hyper-focusing on where deficiencies exist but rather recognizing the resilience and strengths of Indigenous peoples [78,80]. By incorporating an assessment of resilience and protective factors that prevent complexity, a PCAT for Indigenous patients may provide an avenue for HCPs to recognize the rich legacy of Indigenous strengths, work alongside the patient to advance Indigenous health equity, and acknowledge the dominance of Western health models [81]. ...
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Patient complexity assessment tools (PCATs) are utilized to collect vital information to effectively deliver care to patients with complexity. Indigenous patients are viewed in the clinical setting as having complex health needs, but there is no existing PCAT developed for use with Indigenous patients, although general population PCATs may contain relevant content. Our objective was to identify PCATs that include the inquiry of domains relevant in the care of Indigenous patients with complexity. A scoping review was performed on articles published between 2016 and 2021 to extend a previous scoping review of PCATs. Data extraction from existing frameworks focused on domains of social realities relevant to the care of Indigenous patients. The search resulted in 1078 articles, 82 underwent full-text review, and 9 new tools were identified. Combined with previously known and identified PCATs, only 6 items from 5 tools tangentially addressed the domains of social realities relevant to Indigenous patients. This scoping review identifies a major gap in the utility and capacity of PCATs to address the realities of Indigenous patients. Future research should focus on developing tools to address the needs of Indigenous patients and improve health outcomes.
... A report on health disparities in Saskatoon, Saskatchewan, described First Nations peoples to be "more likely to experience poor health outcomes in essentially every indicator possible" (page 27) [11]. This greater burden of ill health among Indigenous peoples in Canada has been attributed to systemic racism (associated with differences in power, resources, capacities, and opportunities) [9,10,12,13] and intergenerational trauma (stemming from the past and ongoing legacy of colonization such as experienced through the Indian residential and Day school systems, the Sixties Scoop, and the ongoing waves of Indigenous child and youth apprehensions seen in the foster and child care structures that remove Indigenous children from their family, community and traditional lands) [3,9,10,[12][13][14][15][16][17]. These traumatic historical events, along with ongoing inequities, such as: socioeconomic and environmental dispossession; loss of language; disruption of ties to Indigenous families, community, land and cultural traditions; have been reported to exacerbate drastically and cumulatively the physical, mental, social and spiritual health of Indigenous peoples in Canada, creating "soul wounds" (3 p.208) that require interventions beyond the Westernized biomedical models of health and healing [3,9,10,[12][13][14][15][16][17][18][19][20][21]. ...
... A report on health disparities in Saskatoon, Saskatchewan, described First Nations peoples to be "more likely to experience poor health outcomes in essentially every indicator possible" (page 27) [11]. This greater burden of ill health among Indigenous peoples in Canada has been attributed to systemic racism (associated with differences in power, resources, capacities, and opportunities) [9,10,12,13] and intergenerational trauma (stemming from the past and ongoing legacy of colonization such as experienced through the Indian residential and Day school systems, the Sixties Scoop, and the ongoing waves of Indigenous child and youth apprehensions seen in the foster and child care structures that remove Indigenous children from their family, community and traditional lands) [3,9,10,[12][13][14][15][16][17]. These traumatic historical events, along with ongoing inequities, such as: socioeconomic and environmental dispossession; loss of language; disruption of ties to Indigenous families, community, land and cultural traditions; have been reported to exacerbate drastically and cumulatively the physical, mental, social and spiritual health of Indigenous peoples in Canada, creating "soul wounds" (3 p.208) that require interventions beyond the Westernized biomedical models of health and healing [3,9,10,[12][13][14][15][16][17][18][19][20][21]. ...
... This greater burden of ill health among Indigenous peoples in Canada has been attributed to systemic racism (associated with differences in power, resources, capacities, and opportunities) [9,10,12,13] and intergenerational trauma (stemming from the past and ongoing legacy of colonization such as experienced through the Indian residential and Day school systems, the Sixties Scoop, and the ongoing waves of Indigenous child and youth apprehensions seen in the foster and child care structures that remove Indigenous children from their family, community and traditional lands) [3,9,10,[12][13][14][15][16][17]. These traumatic historical events, along with ongoing inequities, such as: socioeconomic and environmental dispossession; loss of language; disruption of ties to Indigenous families, community, land and cultural traditions; have been reported to exacerbate drastically and cumulatively the physical, mental, social and spiritual health of Indigenous peoples in Canada, creating "soul wounds" (3 p.208) that require interventions beyond the Westernized biomedical models of health and healing [3,9,10,[12][13][14][15][16][17][18][19][20][21]. ...
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Background Indigenous youth in Canada face profound health inequities which are shaped by the rippling effects of intergenerational trauma, caused by the historical and contemporary colonial policies that reinforce negative stereotypes regarding them. Moreover, wellness promotion strategies for these youth are replete with individualistic Western concepts that excludes avenues for them to access holistic practices grounded in their culture. Our scoping review explored strategies, approaches, and ways health and wellness can be enhanced by, for, and with Indigenous youth in Canada by identifying barriers/roadblocks and facilitators/strengths to enhancing wellness among Indigenous youth in Canada. Methods We applied a systematic approach to searching and critically reviewing peer-reviewed literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR] as a reporting guideline. Our search strategy focused on specific keywords and MeSH terms for three major areas: Indigenous youth, health, and Canada. We used these keywords, to systematically search the following electronic databases published in English between January 01, 2017, to May 22, 2021: Medline [Ovid], PubMed, ERIC, Web of Science, Scopus, and iportal. We also used hand-searching and snowballing methods to identify relevant articles. Data collected were analysed for contents and themes. Results From an initial 1695 articles collated, 20 articles met inclusion criteria for this review. Key facilitators/strengths to enhancing health and wellness by, for, and with Indigenous youth that emerged from our review included: promoting culturally appropriate interventions to engage Indigenous youth; using strength-based approaches; reliance on the wisdom of community Elders; taking responsibility; and providing access to wellness supports. Key barriers/roadblocks included: lack of community support for wellness promotion activities among Indigenous youth; structural/organizational issues within Indigenous communities; discrimination and social exclusion; cultural illiteracy among youth; cultural discordance with mainstream health systems and services; and addictions and risky behaviours. Conclusion This scoping review extracted 20 relevant articles about ways to engage Indigenous youth in health and wellness enhancement. Our findings demonstrate the importance of promoting health by, and with Indigenous youth, by engaging them in activities reflexive of their cultural norms, rather than imposing control measures that are incompatible with their value systems.