Article

Historical Trauma Among Indigenous Peoples of the Americas: Concepts, Research, and Clinical Considerations

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Abstract

Indigenous Peoples of the Americas have experienced devastating collective, intergenerational massive group trauma and compounding discrimination, racism, and oppression. There is increasing evidence of emotional responses to collective trauma and losses among Indigenous Peoples, which may help to inform ways of alleviating psychological suffering and unresolved grief. Tribal cultural and regional differences exist which may impact how the wounding across generations and within an individual's lifespan are experienced and addressed. This article will review the conceptual framework of historical trauma, current efforts to measure the impact of historical trauma upon emotional distress, and research as well as clinical innovations aimed at addressing historical trauma among American Indians/Alaska Natives and other Indigenous Peoples of the Americas. We will discuss assessment of historical trauma and implications for research and clinical as well as community interventions, and conclude with recommendations.

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... Responses to historical trauma need to address the multigenerational effects on individuals, families, communities, and cultures (Evans-Campbell, 2008). Integrated healthcare providers need to have a strong understanding of historical trauma to better address the roots causes of the crisis, including housing inequities, health disparities, disconnection from relationships including natural sensory ties, ongoing exposure to violence, and the continued socio-political conditions of colonialism (Miller, 1988;Brave Heart, 1998;Brave Heart, 2003;Evans-Campbell, 2008;Brave Heart et al., 2011;Tuck & Yang, 2013;Mohatt et al., 2014;Darroch et al., 2017;Midgley, 2018;Mkandawire-Valhmu, 2018;Curtis et al., 2019;Thistle & Smylie, 2020). People need social determinants of health and the necessary social and economic conditions for housing security to be on a stable recovery path (Bowen, Savino, & Irish, 2019;Healthy People, 2030). ...
... Indigenous practitioners advocate a resiliency focus to address barriers more effectively to culturally relevant, life-enhancing services (Brave Heart et al., 2011;Gray et al., 2018;Linklater, 2014;Weaver, 2019;Yellow Bird, 2011). Restorative organizational efforts require a resiliency-focus for integrated healthcare to not pathologize people experiencing houselessness and to recognize that "telling current and future social workers to take care of themselves simply is not a sufficient way to address toxic work environments" (Bransford & Cole, 2019, p. 271;Healthy People, 2030). ...
... Settler colonialism operates through "biopolitical and geopolitical management" of Indigenous life (e.g., people, plants, herbs, animals, waters, minerals, and lands) through destruction for profit gained by claiming ownership of resources, including the forceful removal of Indigenous people from their lands resulting in Indigenous people living in urban areas disproportionately experiencing houselessness and incarceration (Tuck & Yang, 2013). There is an urgent need to address and prevent racial health disparities among Indigenous people, including higher rates of depression, substance use, PTSD, complicated grief, alcohol-related deaths, suicide, HIV and AIDS, Hepatitis C, and loss of ancestral ties (Brave Heart et al., 2011). ...
Article
Objective: Housing and Urban Development (HUD) Continuums of Care (COCs) are responsible for providing entry to integrated healthcare for unhoused people toward housing stability. A client’s safety is a crucial variable to receive services. A comprehensive safety strategy understands the importance of relationship quality for clients and their multidisciplinary healthcare teams (MHT) to prevent safety incidents. Greater depth of knowledge on participant experiences informs the development of a process model for implementing the Community Resiliency Model (CRM) for crisis prevention response to decrease health disparities among unhoused Indigenous peoples in Albuquerque. Methods: This qualitative key informant study applied an ecological lens on Relational-Cultural Theory (RCT) and 24 participant interview content analysis. Participants include unhoused people who self-identified with Native American, about accessing and receiving homeless services and members of their MHT across COC agencies. Findings: Participants shared a congruent understanding of the interpersonal, multidisciplinary, and organizational resilience factors for crisis stabilization and prevention. Integrated healthcare providers identified cohesion when an MHT has the organizational supports needed to consistently provided compassionate care and relevant recovery options. Interpersonal resilience emerged as the sense of belonging experienced in a compassionate and accepting relationship. Relational courage is a key facilitator of interpersonal resilience when an integrated healthcare provider can clarify with a client what is the most important and brings purpose or meaning. Participants emphasized multilevel factors for the cultivation of hope in recovery at the heart of crisis prevention. Discussion: The findings provide a rationale for a paradigm shift to resilience for housing stability. CRM wellness skills can enhance growth-fostering connection and cultural relevance for safety planning. Significantly, cohesion enhances the capacity of an MHT to support a client’s success in recovery. Cohesion correlates with integrated healthcare providers in their OK Zones. Ethical distress escalated crises and contributed to barriers preventing safety incidents. The implications for integrated healthcare and housing policy are to increase multilevel support for organizations to provide workforce training, implementation support, and solutions to sustain MHT cohesion and maintain intra-organizational systems. Cohesion is a key variable to enhance the capacity for a comprehensive safety strategy to be successful.
... Cultural and spiritual traditions are central to grandparents' lives, especially in the wake of historical trauma and oppression (Brave Heart et al., 2011;Campbell & Evans-Campbell, 2011;Hanson & Hampton, 2000). These traditions serve as a means of healing and as protective factors for children and families (Cournoyer, 2012;Silvey, 2004;Silvey, et al., 2007). ...
... War, genocide, colonization, cultural suppression, and oppression by those who did not understand or respect traditional ways of living nearly eradicated Indigenous communities. They further experienced a corresponding decline in resources and opportunities, the denial of spiritual beliefs, and the near eradication of tribal cultures, languages, and traditional ways of living (Brave Heart et al., 2011;Goodkind, Hess, Gorman, & Parker, 2012). Understanding resilience in the context of life experiences and historical changes, which include forced relocation and displacements, reconfigurations, violent dispossession of property and homeland, and continuing marginalization borne of intentional and unintentional actions and policies is critical (Brave Heart et al., 2011;Montgomery, Miville, Winterowd, Jefferies, & Baysden, 1998). ...
... They further experienced a corresponding decline in resources and opportunities, the denial of spiritual beliefs, and the near eradication of tribal cultures, languages, and traditional ways of living (Brave Heart et al., 2011;Goodkind, Hess, Gorman, & Parker, 2012). Understanding resilience in the context of life experiences and historical changes, which include forced relocation and displacements, reconfigurations, violent dispossession of property and homeland, and continuing marginalization borne of intentional and unintentional actions and policies is critical (Brave Heart et al., 2011;Montgomery, Miville, Winterowd, Jefferies, & Baysden, 1998). ...
Article
Recent educational reforms tend to focus on reading and math, possibly to the detriment of history education. As university students enroll in family perspective courses, their lack of historical knowledge may result in diminished understanding of local and global events that have affected the course of global families and human development. This study examines the connection between students’ self-reported historical knowledge and cultural competence. Self-reported measures of historical literacy and cultural competency were collected from 123 students at a Mountain West urban university campus using a quantitative questionnaire. Results show that historical literacy may play a small but statistically significant role in cultural competence. Suggestions are made for future research and curriculum direction.
... Multiple researchers have attributed the origins of modern social adversities to historical traumas and atrocities wrought upon AI/AN people spanning generations. [14][15][16] While this association requires further investigation, emerging studies suggest that this historical trauma may have led to the acquisition of intergenerational stress. 3,14,17 Adverse experiences such as poverty, racism, domestic violence, and unintentional injuries can lead to poor physical and mental health outcomes among AI/AN persons. ...
... [14][15][16] While this association requires further investigation, emerging studies suggest that this historical trauma may have led to the acquisition of intergenerational stress. 3,14,17 Adverse experiences such as poverty, racism, domestic violence, and unintentional injuries can lead to poor physical and mental health outcomes among AI/AN persons. 2,3 Poor physical and mental health outcomes can result from lack of access to care, access to healthy foods, built environment, and opportunities related to educational attainment and employment. ...
... 2,3 Poor physical and mental health outcomes can result from lack of access to care, access to healthy foods, built environment, and opportunities related to educational attainment and employment. 2,14 Researchers have established that ongoing health disparities among AI/AN populations in the United States 3 persist in virtually all areas of health, including chronic disease, 18 cancer, 6 and most recently, the COVID-19 pandemic. 19 AI/AN populations and communities continue to find strength through tribal culture and traditional practices. ...
Article
Objectives: To explore current literature on social determinants of health (SDOH) and cancer among American Indian and Alaska Native (AI/AN) populations. Methods: We searched Ovid MEDLINE®, CINAHL, and PsycINFO databases for articles published during 2000 to 2020, which included terms for SDOH and cancer occurrence in AI/AN populations. We derived the data extraction elements from the PROGRESS-Plus framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity extension guided the evidence map. Results: From 2180 screened articles, 297 were included. Most were observational (93.9%), employed a cross-sectional design (83.2%), were categorized as cancer occurrence and surveillance research (62%), and included no cancer-related risk factors (70.7%). Race, gender, and place were the most frequently included PROGRESS-Plus categories. Religion, relationship features, and characteristics of discrimination were least common. Only 12% of articles mentioned historical/current trauma or historical context. Conclusions: Gaps exist in our understanding of SDOH as drivers of cancer disparities in AI/AN populations. Future studies in health equity science may incorporate historical and cultural factors into SDOH frameworks tailored for AI/AN populations.
... American Indian and Alaska Native (AI/AN) populations make up about 1.7% of the total U.S. population. 1 While AI/AN account for only a small part of the population, they have considerably higher rates of substance use compared with other racial and ethnic groups in the United States. [1][2][3][4][5] Researchers have established that legacies of colonialism and genocide are factors of historical trauma that exacerbate substance use challenges for AI/AN populations. 1,[5][6][7] Additional established risk factors include exposure to violence, high rates of unemployment, discrimination and racism, lack of health insurance, as well as inadequate educational access as social determinants of health contributing to higher rates of substance use for AI/AN. ...
... [1][2][3][4][5] Researchers have established that legacies of colonialism and genocide are factors of historical trauma that exacerbate substance use challenges for AI/AN populations. 1,[5][6][7] Additional established risk factors include exposure to violence, high rates of unemployment, discrimination and racism, lack of health insurance, as well as inadequate educational access as social determinants of health contributing to higher rates of substance use for AI/AN. 1,8 These factors combined with high rates of mental health challenges and chronic illness suggest that addressing health disparities in AI/AN should be an urgent public health issue. ...
... 8,9 The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 13% of the AI/AN population in the United States need SUD treatment, but only 3.5% actually access treatment. 8 Historical trauma, genocide and colonial legacies, and current-day forms of structural racism and violence continue to impact the health and well-being of AI/AN populations 1,[5][6][7] and are likely connected to high rates of substance use and mental health challenges. Cultural erasure, the forced removal of AI/AN children from their families into boarding schools, eugenics, and forced sterilization, are some of the atrocities that AI/AN have faced. ...
Article
Background and purpose: The purpose of this study was to learn about the Abenaki Indigenous communities' access to services, specifically, their beliefs and knowledge about different types of mental health and substance abuse services and supports within their communities. Methods: This was an exploratory qualitative study using a focus group approach. Two focus groups were conducted in spring 2020 with community members and tribal leaders from different Abenaki Bands in Franklin, Chittenden, and Addison Counties and the Northeast Kingdom in Vermont. Participants were recruited via a mix of convenience and snowball sampling approaches. Results: A total of 15 Abenaki community members participated in 2 separate focus groups, including 5 current and former Chiefs who served or were currently serving as the primary leadership of this state-recognized tribe. Members of the Abenaki community communicated that the loss and erasure of their culture combined with lack of trust of community support agencies impacted the ways in which the Abenaki community conceptualizes health and wellness for themselves and thus impacts parenting and youth substance use as well as opioid use and prescription drug misuse for participants in this study. Conclusion: Abenaki Indigenous experience many obstacles to effective prevention and intervention services. Recruitment of American Indian and Alaska Native (AI/AN) individuals, specifically Abenaki, into the health and mental health workforce can support health equity efforts for this population. Finally, better efforts to foster and support AI/AN culture, specifically Abenaki culture, can support substance use and suicide prevention with this vulnerable community.
... This has important implications for First Nations learners, their families, and their communities throughout Australia, and indeed, throughout many countries of the world. Not only have these peoples experienced the impacts and associated grief from violent and socially disruptive invasion and colonization of their homelands and the forced removal of their children from families and communities, but also from compounding institutional and interpersonal discrimination, marginalization, racism, and oppression Heart et al., 2011;Nicolai and Saus, 2013;Kirmayer et al., 2014). Milroy (2005) explains that trauma is transmitted across generations in First Nations communities due to the impact on attachment relationships and parenting and family functioning, the impact on parental physical and mental wellbeing, and the disconnection and alienation of individuals from extended family, culture, land, and society. ...
... Guideline five states that a trauma-aware approach should be developed in consultation with First Nations peoples and leaders to ensure the cultural strength of the approach. There are important and powerful learnings regarding the impact of historical trauma on generations of Indigenous peoples throughout Australia and the world, that need to be considered in a trauma-aware education response Heart et al., 2011;Nicolai and Saus, 2013;Kirmayer et al., 2014;Miller and Berger, 2020). ...
Article
Full-text available
The National Guidelines for Trauma-Aware Education in Australia were developed in response to a rapidly growing interest in trauma-aware education across the country and to address the lack of site- and system-level guidance for application of trauma-aware practices in schools and early childhood services. Although research into trauma-aware education was increasing and resources and training and support programs were being developed across Australia, there were no nationally agreed upon guidelines providing consistency to thinking, policy, and practice. Drawing from public health and health promotion models for establishing guidelines for trauma-aware policy and practice, the Guidelines were developed through a thorough process of incorporating research evidence and expert and end-user input. The Guidelines were developed across 2017–2019 and were finalized in 2021 and provide an important first step in a national response to trauma-aware education in Australia. This article will describe the “story” behind the development of the Guidelines. It is hoped that this “story” will help others considering development of systemic resources to inform the establishment and enhancement of trauma-aware policy and practice in schools and early childhood education services.
... Historical trauma is defined as "cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma" (Brave Heart, 2003). Importantly, and perhaps unsurprisingly, historical trauma is strongly related to the experience of lifetime traumatic events as well as to the development of conditions such as unresolved grief, complicated/prolonged grief, PTSD, depression, and substance abuse (Heart et al., 2011). ...
... Many indigenous communities have developed their own traditional therapeutic interventions, which have shown to be very effective in addressing issues such as substance misuse and trauma. However, these interventions are usually focused not on DSM diagnoses but on a holistic concept of well-being and health, emphasizing a strong connection to ancestral lands and revival of cultural and spiritual traditions, and potentially involving an entire community as the agent of healing (Heart et al., 2011;Jacob, 2013). ...
Article
Full-text available
Post-traumatic stress disorder (PTSD), a common condition with potentially devastating individual, family, and societal consequences, is highly associated with substance use disorders (SUDs). The association between PTSD and SUD is complex and may involve adverse childhood experiences (ACEs), historical and multi-generational traumas, and social determinants of health as well as cultural and spiritual contexts. Current psychosocial and pharmacological treatments for PTSD are only modestly effective, and there is a need for more research on therapeutic interventions for co-occurring PTSD and SUD, including whether to provide integrated or sequential treatments. There is a current resurgence of interest in psychedelics as potential treatment augmentation for PTSD and SUDs with an appreciation of the risks in this target population. This paper reviews the historical perspective of psychedelic research and practices, as well as the intersection of historical trauma, ACEs, PTSD, and SUDs through the lens of New Mexico. New Mexico is a state with high populations of Indigenous and Hispanic peoples as well as high rates of trauma, PTSD, and SUDs. Researchers in New Mexico have been leaders in psychedelic research. Future directions for psychedelic researchers to consider are discussed, including the importance of community-based participatory approaches that are more inclusive and respectful of Indigenous and other minority communities.
... The phenomenon is studied as historical trauma (Chase & Ullrich, 2022;Deloria et al., 2018;Mohatt et al., 2014;Sotero, 2006;Wexler & Gone, 2012) or the Soul Wound (Duran & Duran, 1995). Historical trauma is defined as the shared experiences by groups of individuals (Brave Heart et al., 2011;Mohatt et al., 2014) who faced deliberate "genocidal or ethnocidal intent" (Waters et al., 2011, pg. 181) through hideous acts of colonization across generations (Brave Heart & DeBruyn, 1998;Crawford, 2014;Gone, 2013;Kirmayer et al., 2014;Sotero, 2006). ...
Article
Full-text available
In this Indigenous grounded, transformative sequential explanatory study, the author examines the influence an American Indian way of knowing educational paradigm had on cultural connectedness in a sample (n = 41) of American Indian youths attending a public school on a federally recognized Indian reservation. The author uses ethnographic writing to share his cultural journey with American Indian cultural immersion teachers. Participants completed a survey packet including a demographic form and, an adapted cultural connectedness survey. Results indicated that positive aspects of an American Indian way of knowing educational paradigm were associated with increased cultural connectedness (Spirituality, Identity, and Traditions) for American Indian youths. The author also sought to capture youth participants' perspectives to develop a deeper understanding of how they conceptualize cultural connectedness resulting in the identification of eleven culturally specific categories. These findings may help inform a broader development and application of an American Indian way of knowing instructional model that contributes to strengthening cultural identity in American Indian youths through culturally sustaining and revitalizing pedagogies.
... 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). This approach inadvertently reifies the image of indigenous and other marginalized communities as inherently traumatized and "damaged" (Hartmann et al., 2019;Teo, 2010;Tuck, 2009). ...
Article
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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.
... The phenomenon is studied as historical trauma (Chase & Ullrich, 2022;Deloria et al., 2018;Mohatt et al., 2014;Sotero, 2006;Wexler & Gone, 2012) or the Soul Wound (Duran & Duran, 1995). Historical trauma is defined as the shared experiences by groups of individuals (Brave Heart et al., 2011;Mohatt et al., 2014) who faced deliberate "genocidal or ethnocidal intent" (Waters et al., 2011, pg. 181) through hideous acts of colonization across generations (Brave Heart & DeBruyn, 1998;Crawford, 2014;Gone, 2013;Kirmayer et al., 2014;Sotero, 2006). ...
Article
Full-text available
Abstract: In this Indigenous grounded, transformative sequential explanatory study, the author examines the influence an American Indian way of knowing educational paradigm had on cultural connectedness in a sample (n = 41) of American Indian youths attending a public school on a federally recognized Indian reservation. The author uses ethnographic writing to share his cultural journey with American Indian cultural immersion teachers. Participants completed a survey packet including a demographic form and, an adapted cultural connectedness survey. Results indicated that positive aspects of an American Indian way of knowing educational paradigm were associated with increased cultural connectedness (Spirituality, Identity, and Traditions) for American Indian youths. The author also sought to capture youth participants' perspectives to develop a deeper understanding of how they conceptualize cultural connectedness resulting in the identification of eleven culturally specific categories. These findings may help inform a broader development and application of an American Indian way of knowing instructional model that contributes to strengthening cultural identity in American Indian youths through culturally sustaining and revitalizing pedagogies. Keywords: American Indian, Indigenous methodologies, ethnography, cultural connectedness, transformative mixed methods.
... While all populations are at risk for exposure to childhood stressors (Merrick et al., 2019), AI/AN individuals' higher mean ACEs scores and ACEs frequencies across domains is a direct result of historically traumatic events and intergenerational effects, including colonization, forced assimilation, and resulting traumatic responses (Brave Heart et al., 2011;Connolly et al., 2019;Elm, 2020;Evans-Campbell, 2008). In fact, previous research demonstrated that the cumulative impact of ACEs increased the odds of experiencing symptoms of post-traumatic stress disorder (PTSD), depression, poly-substance use, and suicide attempts, specifically for those with higher levels of historical loss thinking, in a sample of AI/AN adults from a U.S. plains reservation (Brockie et al., 2015). ...
Article
Background Adverse childhood experiences (ACEs) research has yielded important information regarding ACEs prevalence and impacts; however, few studies have included American Indian/Alaska Native (AI/AN) populations. Objective We aimed to update and expand the ACEs literature by using recent data (2009–2018; over 50% from 2015 to 2017); using a large, nationally representative sample (total N = 166,606) and AI/AN sub-sample (N = 3369); and including additional covariates (i.e., sex, age, income, education) to provide a comprehensive understanding of ACEs across diverse populations. Participants and setting Data were from the CDC's BRFSS, a standardized scale used in most ACEs literature, to improve generalizability of study findings, which may contribute to investigating future ACEs trends. Methods Descriptive statistics and negative binomial regression analyses were conducted to examine the frequency of ACEs and the eight ACEs domains across racial/ethnic and sex groups. Results AI/ANs had the highest ACEs compared to all racial/ethnic groups. Females had higher mean ACEs compared to males of the same racial/ethnic group; significant differences were identified between non-Hispanic White (NHW) females and NHW males, and between Hispanic females and Hispanic males. Across all 10 stratified subgroups, AI/AN females had the highest average ACEs followed by AI/AN males. Emotional abuse was the most reported ACEs domain across all individuals, and family incarceration was the lowest. AI/AN females and males had the highest ACEs frequencies in family substance use, witnessing intimate partner violence, and sexual and emotional abuse. Conclusions Findings have important implications for public health intervention and prevention efforts that may mitigate the impact of ACEs across racial/ethnic groups, particularly for AI/AN populations.
... There are bodies of work that highlight modalities for addressing the racial needs of BIPOC clients. For example, a few include the Historical Trauma and Unresolved Grief (HTUG) Intervention for American Indians (Heart et al., 2011), the Racial Encounter Coping Appraisal and Socialization Theory (ReCAST; Anderson & Stevenson, 2019), and the Healing Ethno-Racial Trauma (HEARTS) model (Chavez-Duenas et al., 2019). However, these modalities remain highly theoretical with less documented translation to practice, implementation manualization, or support for clinicians who seek to implement. ...
... 7). Such experiences lead to Historical Trauma Response, as well as unresolved historical grief (Brave Heart, Chase, Elkins, & Altschul, 2011). In a study conducted by Reinschmidt and colleagues (2015), several specific themes emerged for groups suffering from Historical Trauma, such as traditional and contemporary losses, collective and individual resilience, and adversity. ...
Thesis
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Abrams, Chaya M. Partners in story: Connecting to sacred stories in Historical Trauma Response within psychotherapy. Published Doctor of Counselor Education and Supervision dissertation, Adams State University, 2019. Current findings in counseling literature suggest that persons having experienced trauma suffer disruption in multiple areas of functioning, and may benefit from psychotherapeutic intervention and connection. Despite these findings, it has been found that counselors and researchers lack understanding of posttraumtic response and experience ambivalence associated with immersion into the deeper narratives of survivors in post-trauma. One manner in which to connect with persons having experienced historical trauma response is through sacred stories, and therefore, a qualitative multiple case study depicting use of sacred stories within psychotherapy with persons having experienced HTR was conducted. Results of the multiple case study indicated that a sacred component is attached to stories based on multiple experiences of individuals having experienced HTR, and that the self disclosure of psychotherapists treating clients in HTR is an aspect of a therapeutic pact, which in itself is a sacred story. Results also showed that "a coming home" is a metaphor used to describe safety of sacred stories and is extended to therapeutic connection, and that personal associations with stories of clients and clinicians blend to create a deeper therapeutic connection. A final result showed that clinicians' act of witnessing sacred stories allows clients to "regain authorship" of their own stories. Future recommendations for researchers and psychotherapists are discussed.
... Historical trauma refers to a cumulative pattern of harm (see Brave Heart et al., 2011). It is described as being constellated around physical and psychological violence, segregation and displacement, economic deprivation and cultural dispossession (Sotero, 2006). ...
... Many groups worldwide have suffered from collective violence, which is instrumental and group-based, and take different forms such as colonization, ethnic persecution, slavery, genocide or armed conflict (WHO, 2002). The material and psychological consequences of collective victimization often continue to affect communities generations later, as historical trauma (Brave Heart et al., 2011). Understanding how exactly people make sense of collective violence against their group, and which issues people are concerned with in the aftermath of collective violence, is an important task for social psychology that has been gaining more attention (Bar-Tal et al., 2009;Noor et al., 2017;Vollhardt, 2020). ...
Article
Social psychological research on collective victimhood has often focused on comparisons between the ingroup's and outgroups' collective victimization (i.e. comparative victim beliefs such as competitive victimhood or inclusive victim beliefs). This qualitative study examines how people in different contexts of collective victimization and its aftermath make sense of items commonly used to assess comparative victim beliefs, and how they extend or challenge these constructs and their underlying assumptions. We used thematic analysis to analyse eight focus group discussions among four minority groups in the United States with historical or more recent experiences of collective victimization (Armenian Americans, Burundian refugees, Jewish Americans and Nepali‐speaking Bhutanese refugees). Findings extend commonly assessed comparative victim beliefs and reveal participants' critical perspectives on these constructs. The findings also highlight the dialectical structure of collective victim beliefs: Participants not only endorsed but also rejected comparative victim beliefs, and relatedly described both ingroup power and outgroup power in the context of their group's victimization. These findings extend existing social psychological literature on comparative victim beliefs and intergroup relations.
... Because historical trauma impacts individuals differently based upon their experiences as well as their built up resilience, it is prudent to look at NH historical trauma experiences across the lifespan. We know from work in other communities that experiences are not fixed, but rather are interpreted and re-interpreted based on age and circumstance [61]. We also have some evidence to indicate that cultural engagement and knowledge mediates against historical trauma. ...
Article
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Native Hawaiians (NH), like other Indigenous peoples, continue to experience the subversive impacts of colonization. The traumatic effects of colonization, especially the forced relocation from land that sustained their life and health, have led to complex, interconnected health disparities seen today. NHs have described a collective feeling of kaumaha (heavy, oppressive sadness) resulting from mass land dispossession, overthrow of the Hawaiian Kingdom, cultural loss, and early loss of loved ones. Although historical trauma is linked to high rates of substance misuse, depression, suicidality, and other mental health disparities in American Indian populations. However, the link between NH historical trauma and health disparities among NHs has been less explored. This qualitative study used Indigenous talk story interviews with 34 NH ʻōpio (youth) and ka lawelawe (service providers) to explore how NH ʻōpio understand and experience historical trauma. Eight themes and 35 sub-themes were identified covering individual, community, and systemic domains representing the first step in addressing NH historical trauma.
... Irrespective of the many differences in how genocide plays out, these events all inflicted severe and lasting harm to the survivors. The cumulative consequences of the historical traumas experienced by Indigenous Peoples have been described as causing a 'soul wound' that has profoundly affected individuals across generations [6]. ...
Article
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The policies and actions that were enacted to colonize Indigenous Peoples in Canada have been described as constituting cultural genocide. When one considers the long-term consequences from the perspective of the social and environmental determinants of health framework, the impacts of such policies on the physical and mental health of Indigenous Peoples go well beyond cultural loss. This paper addresses the impacts of key historical and current Canadian federal policies in relation to the health and well-being of Indigenous Peoples. Far from constituting a mere lesson in history, the connections between colonialist policies and actions on present-day outcomes are evaluated in terms of transgenerational and intergenerational transmission processes, including psychosocial, developmental, environmental, and neurobiological mechanisms and trauma responses. In addition, while colonialist policies have created adverse living conditions for Indigenous Peoples, resilience and the perseverance of many aspects of culture may be maintained through intergenerational processes.
... These historical losses and traumas are perpetuated in the modern context through continued interpersonal and institutional racism, thus creating barriers for healing (Skewes & Blume, 2019). European colonization brought the systematic destruction and criminalization of traditional cultural activities, including outlawing speaking Indigenous languages, religious practices, and burial practices and ceremonies (Brave Heart et al., 2011;McKenzie, 2022). Further, historical trauma led to decreased availability of culturally based reinforcers (e.g., powwows, sweats) that adolescents could engage in instead of using substances by making the practice of such culturally based reinforcers illegal in some areas (Hawkins et al., 2004;Spillane et al., 2013;Spillane & Smith, 2007). ...
Article
Background: Adolescent alcohol use is a significant public health concern and rates of alcohol use are higher among American Indian (AI) adolescents than national samples of non-AI youth. A potential factor in understanding AI alcohol use is cultural identity, which can vary widely based on experiences of historical trauma. We used latent class analysis to examine cultural identity in AI and White adolescents and their alcohol use outcomes in relation to the latent class solutions. Methods: The samples included 3189 AI adolescents (Mage = 14.76, 48.9% female) and 1579 White adolescents (Mage = 15.56, 48.7% female) living on or near a reservation. Participants completed self-report measures of AI and White cultural identity affiliation, alcohol use, and alcohol-related problems. We examined (1) the best-fitting latent class solution with respect to American Indian (AI) and White cultural identity; (2) equivalence of the latent class solution; and (3) alcohol use outcomes across the optimal latent class solution. Results: Latent profile analyses indicated an optimal 3-class solution in both the AI and White samples, which differed by level of affiliation with AI and White cultural identity. While the optimal number of classes were similar across racial groups (configural profile similarity), the nature of the classes differed (structural profile dissimilarity). The three classes represented low overall scores on AI and White cultural identity (Marginalized), a mixture of high and low scores on AI and White cultural identity (Third Culture), and overall high scores on AI and White cultural identity (Bicultural). Alcohol-related problems predicted membership in the Third Culture class compared with the Marginalized class and the Bicultural class. Specifically, youth in the Third Culture class reported significantly fewer alcohol-related problems than youth in the Marginalized and Bicultural classes. Alcohol use did not predict latent class membership. Conclusions: The future-oriented nature of the Third Culture class may provide protection against adverse alcohol-related outcomes. Research is needed to test interventions that target greater future orientation and future plans to integrate culture into adolescents' lives.
... These tragic revelations are currently reverberating in Indigenous communities and likely contributing to the negative effects of the COVID-19 pandemic on people who live with OUD and their families. These triggers highlight the need for culturally and familybased healing approaches that respond to the complex trauma that people with OUD may have experienced as the multi-generational consequences of colonial policies (Brave Heart et al., 2011;Fiedeldey-Van Dijk et al., 2017;Pomerville & Gone, 2019;Restoule et al., 2015;Ritland et al., 2020;Rowan et al., 2014). Colonial policies have facilitated multi-generational mental, physical, and sexual abuse in residential and day schools, which are the root causes of high addictions rates today (Dell et al., 2011;Health Canada, 2015;Marsh et al., 2015). ...
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The opioid crisis is disproportionately impacting Indigenous communities in Canada. There is a need to evaluate practical approaches to recovery that include community-based opioid agonist treatment (OAT) and integration of cultural treatment models. Naandwe Miikan, translated as The Healing Path, is an OAT program that blends clinical and Indigenous healing concepts and providers in a community-based setting. Aside from OAT pharmaceutical treatment, clients work with Indigenous counsellors that integrate culture with treatment, such as land-based activities, that reconnect the community to Indigenous teachings and harvesting. In this paper, we present a case study showcasing community advocacy in creating innovative funding models and engaging with clinicians to provide a shared care OAT model with traditional Indigenous counselling, cultural programs, and data sovereignty. Policy needs are identified.
... Yet, as social medicine and related fields have argued for some time, structural level factors underlie the development and distribution of SDOH and have historically set up and put into motion inequities in health [12,13]. Historical factors such as colonization, forced repatriation, land loss, and slavery render certain racial-ethnic groups more susceptible to the harmful and detrimental outcomes of the power imbalances embedded within institutions and social life [14][15][16][17]. These inequities are seen in higher rates of cardiovascular disease, diabetes, respiratory disease, hypertension, cancer, and infectious disease in marginalized communities of color [18]. ...
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Background A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. Across the United States, Latinx and Indigenous populations have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial-ethnic minority groups, specifically Latinx and Indigenous Latin American immigrant communities, is needed to alleviate the widespread disparity in new cases and deaths. Methods This study was carried out from August 2020 to January 2021 and used community-based participatory research to engage community partners and build the capacity of community health workers (i.e., promotores de salud) and pre-medical and medical students in conducting qualitative research. The objective of the study was to examine the structural and social determinants of health on perceptions of the coronavirus, its spread, and decisions around COVID-19 testing and vaccination. Data collection included ethnography involving observations in public settings and focus groups with members of Latinx and Indigenous Mexican farm-working communities in the Eastern Coachella Valley, located in the Inland Southern California desert region. A total of seven focus groups, six in Spanish and one in Purépecha, with a total of 55 participants were conducted. Topics covered include perceptions of the coronavirus and its spread, as well as COVID-19 testing and vaccination. Results Using theme identification techniques, the findings identify structural and social factors that underly perceptions held by Latinx and Indigenous Mexican immigrants about the virus and COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions This immigrant population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Study findings indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.
... Colonization results in historical trauma, 52 which is the cumulative emotional and psychological wounding that Indigenous people experience over their lifespans and across generations. Historical trauma impacts the well-being 53 of Indigenous individuals, families, and communities. ...
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We are grateful for this opportunity to provide examples of how federal policies contribute to racial and ethnic health inequities for Indigenous children and families. As we describe below, due to Federal Indian Law, Indigenous communities have faced unique traumas and challenges from a history of colonization and genocide; however, they also bring incredible strengths and protective factors that could be better supported through federal policy. We believe the federal government has a key role to play in reducing disparities for Indigenous communities through changes to federal policies that currently foster inequities in the health and well-being of Indigenous children and families.
... Higher rates of interpersonal violence, poverty, and other life stressors have been found to account for some of the elevated rates of mental illness among AIs (Kong, Roh, Easton, Lee, & Lawler, 2016). However, researchers also have hypothesized that historical trauma (HT) may account for a significant portion of the excess psychiatric morbidity (Brave Heart, Chase, Elkins, & Altschul, 2011). Various definitions of HT have been proposed but the one most often applied to AIs is "cumulative and collective emotional and psychological injury both over the life span and across generations, resulting from a cataclysmic history of genocide" (Brave Heart, 1999, p. 2). ...
Article
Aims: Little research has examined historical trauma (HT), addiction, and mental health problems among general populations of urban American Indians (AIs). This study examined associations to help fill this gap. Methods:This is a secondary analysis of data from a Midwestern urban AI population. Based on a psychological inventory, participants (n=117) were separated into a substance group (n=19), a psychiatric group (n=43), and a control group (n=55). Results of the historical loss scale (HLS, 12 items) and the historical loss-associated symptoms scale (HLASS, 12 items) were examined between the groups. Results:The psychiatric group reported thinking about three specific losses more than the control group and six specific losses more than the substance group. No significant differences were found between the substance group and the control group. The psychiatric group reported nine historical loss-associated symptoms more frequently than the control group. The substance group reported experiencing five symptoms more frequently than the control group. The substance group reported one symptom more frequently than the psychiatric group. Conclusion:Historical trauma appears to affect individuals with psychiatric or substance problems differently from those with no problems. American Indians with psychiatric or substance problems report experiencing some HLAS more often than individuals without these problems. The direction of this relationship is unclear, but it is apparent that historical loss thoughts and symptoms likely affect individuals with psychiatric and substance problems differently than the general public. Providers need to be attuned to these results to understand the experiences of their AI patients.
... This is to indicate that Native peoples' personal and collective histories affect their interactions with their environments (Chandler & Lalonde, 1998), including tribal histories of surviving and thriving (Vizenor, 2008), familial and ancestral histories, and place-based histories. Similarly, the histories of environments affect Native peoples too, including colonial histories (Reid et al., 2019) and historical trauma (Brave Heart et al., 2011;Gone et al., 2019;Mohatt et al., 2014). ...
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According to the Indigenist ecological systems model (Fish et al., 2020), Native American peoples’ histories and cultures are critical to their development. However, the inclusion of Native peoples’ histories and cultures in their environments is complicated by settler colonialism – a societal structure that seeks to eliminate such important contexts. The exclusion of Native peoples’ histories and cultures in their ecologies can have adverse effects on developmental outcomes (Fryberg & Townsend, 2008; Wexler, 2009). Despite this, Native peoples continue to access their histories and cultures throughout their development to promote their well-being (Hartmann et al., 2019). Though the Indigenist ecological systems model offers theoretical insight into the histories and cultures that contour Native peoples’ environments, there are no empirical studies that examine its most basic claims. The present study addresses this gap in the literature by exploring how historical and cultural contexts intersect with the environments that affect Native peoples’ development. Qualitative analyses of Native peoples’ digital story narratives (n=73) suggest that immediate (e.g., parents, peers, school) and distant (e.g., media, government, policies) environments are the most important to Native peoples’ developmental outcomes. Native peoples indicated that culture figured into their immediate and distant environments to a moderate to prominent extent, whereas history did so to a lesser extent. We discuss the implications of these findings for Indigenous development and recommendations for creating a more equitable developmental landscape via partnerships with Native peoples.
Article
This article introduces a Social Work Model of Historical Trauma. The model draws from social work perspectives (ecosystems theory and the life model, human rights philosophy, race-based traumatic stress injury theory and attachment theory), disparities research, social work issues and policy statements, social work ethics and epigenetics. Assessment and intervention in micro, mezzo and macro domains are discussed. The article concludes with a case vignette and model application.
Article
Background: Despite high rates of alcohol abstinence, Alaska Native and American Indian (ANAI) people experience a disproportionate burden of alcohol-related morbidity and mortality. Multiple barriers to treatment exist for this population, including a lack of culturally relevant resources, limited access to or delays in receiving treatment, and privacy concerns. Many ANAI people in the state of Alaska live in sparsely populated rural areas, where treatment access and privacy concerns regarding peer-support programs may be particularly challenging. In addition, prior research demonstrates that many ANAI people prefer a self-management approach to sobriety, rather than formal treatment. Taken together, these factors suggest a potential role for a culturally adapted smartphone app to support ANAI people interested in changing their use of alcohol. Objective: This study was the first phase of a feasibility and acceptability study of a culturally tailored version of an off-the-shelf smartphone app to aid ANAI people in managing or reducing their use of alcohol. The aim of this qualitative needs assessment was to gather insights and preferences from ANAI people and ANAI-serving healthcare providers to guide feature development, content selection, and cultural adaptation prior to a pilot test of the smartphone app with ANAI people. Methods: In October 2018 - September 2019, we conducted semi-structured interviews with 24 ANAI patients 21 years and older and 8 providers in a Tribal healthcare organization in southcentral Alaska. Results: Participants generally endorsed the usefulness of a smartphone app for alcohol self-management. They cited anonymity, 24/7 access, peer support, and patient choice as key attributes of an app. Desired cultural adaptations included ANAI and land-themed design elements, cultural content (e.g., stories from Elders), and spiritual resources. Participants considered an app especially useful for rural-dwelling ANAI people, as well as those who lack timely access to treatment services or prefer to work toward managing their alcohol use outside the clinical setting. Conclusions: This needs assessment identified key features, content, and cultural adaptations that are being implemented in the next phase of the study. In future work, we will determine the extent to which these changes can be accommodated in a commercially available app, the feasibility of implementation, and the acceptability of the culturally adapted version of the app among ANAI users.
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Exceptionally high rates of partner violence perpetration are evident among men returning from prison. Two bodies of scholarship, one on family stress and another on exposure to state violence, each suggest that criminal legal system exposure could promote partner violence perpetration via changes in men’s behavioral health and interpersonal approach and in couples’ conflict dynamics. Such relationships have not been tested in quantitative research. Structural equation models were fitted to longitudinal, couples-based survey data from the Multi-site Family Study on Incarceration, Parenting, and Partnering. Participants included men returning from a state prison term in five U.S. states ( N = 1112) and their committed intimate or co-parenting partners ( N = 1112). Models tested hypothesized pathways from three dimensions of criminal legal system exposure to later partner violence perpetration. In fitted models, men’s childhood criminal legal system exposure predicts their post-prison partner violence perpetration via adult post-traumatic stress symptoms, reactivity, avoidance, and dysfunctional couple conflict dynamics. Men’s cumulative criminal legal system exposure in adulthood predicts their post-prison partner violence perpetration via addiction and dysfunctional couple conflict. These initial results suggest that mass-scale incarceration could worsen partner violence via men’s psychological and interpersonal adaptations to criminal legal system contact, particularly when such contact is sustained or occurs at a developmentally significant period in the life course.
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Conspiracy beliefs are often viewed as a form of psychopathology, closely linked to anxiety, paranoia, and maladaptive traits. However, recent research has brought attention to adaptive and functional aspects of conspiracy theories. This article presents a framework for understanding conspiracy beliefs as a paradoxical adaptation to historical trauma. There is vast evidence that three essential aspects of historical trauma (loss of personal and collective control, status devaluation, and victimhood) constitute the key antecedents of conspiracy beliefs. Although conspiracy theories might be adaptive in times of shared trauma (e.g., war, colonization), they become maladaptive in times of peace and prosperity. The popularity of conspiracy theories in historically traumatized societies threatens individuals’ health and well-being, social trust, cohesiveness, and intergroup harmony.
This paper aims to initiate a discourse that connects allomothers, endemic to African culture, with collective manymothering attachments from a psychoanalytic perspective. This paper illuminates the process by which, beginning with West Africa, Black mothers adapted and carried the process of mothering with them to provide consistent nurturing, responsiveness, and attunement to their infants’ and children’s needs. This process of extending caregiving responsibilities to the community at large, which I have labeled manymothering, has created generations of resistance and resilience that have supported Black people to the present. The psychoanalytic lens of othermothers serves as an adaptive familial structure that has been sustained through intergenerational resilient transmission. The linkage between culture and spirituality as a means of ameliorating trauma and promoting resilience was examined.
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This article is based on an interview study with young and adult Tornedalians, a relatively unknown minority group in the northern part of Sweden. It scrutinizes the informants experiences of identifying with, and navigating within, a minority position in relation to the majority society’s discursive ideas and conceptions about them as national minority group. Through decolonial perspectives focusing on race and place, the analysis illuminates how societal prejudices construct the region of Tornedalen as uncivilized, and where Tornedalians are considered to embody a ”problematic” racialised position. At the same time, however, the informants express practices of both colonial awareness and decolonial resistance. In this way, the customs, culture, political power, and norms related to urbanisation of the Swedish majority society are questioned and challenged from a Finno-Ugric minority standpoint, with emphasis on nature values and knowledges linked to a rural lifestyle.
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A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers our voices, FilCHA shifts power through partnerships in which people who directly experience the conditions that cause inequities have leadership roles and avenues to share their perspectives. We used Pinayism to guide our study of FilCHA, not just for the current crisis State-side, but through a multigenerational, transnational understanding of what knowledges have been taken from us and our ancestors. By naming our collective pain, building a counterspace for love of the community, and generating reflections for our communities, we work toward shared liberation. Harnessing the collective power of researchers as truth seekers and organizers as community builders in affirming spaces for holistic community wellbeing is love in action. This moment demands that we explicitly name love as essential to antiracist public health praxis.
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In this article, the authors use an environmental justice lens to review the history of land management practices: first practiced through stewardship by Indigenous Peoples and then taken over by Western science-based land management. There is a long history of environmental injustice in this Great Turtle Island (North America), and we specifically focus on what is happening in the land currently called the United States. The objective of this article is to explain how to integrate Indigenous Traditional Ecological Knowledge (Indigenous TEK) into Western land management practices through Indigenous-academic partnerships. We address this objective through: 1) a review of the literature on environmental injustice in Indigenous communities, the role Indigenous TEK has in providing sound ecological principles for land management, and examples of Indigenous co-management; 2) explaining how to engage in an Indigenous-academic partnerships; 3) through a quasi-case study we utilize qualitative narrative storytelling to tell the story and process through which some of our authors engaged in an Indigenous-academic partnership, the Earth Partnership-Indigenous Arts and Sciences (EP-IAS), with local Indigenous Tribal Nations through relationship building and dialogue to develop Indigenous-driven restoration and land management in the region; and 4) concluding with a discussion on how Indigenous-academic land management partnerships address environmental justice issues and create meaningful opportunities to address historical inequities. The quasi-case study we provide demonstrates the EP-IAS community engagement model, which exemplifies a mutually beneficial and respectful Indigenous-academic partnership through integrating Indigenous TEK and Western science in land management.
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This study was a secondary data analysis of factors associated with alcohol-related child removal among American Indian/Alaska Native (AI/AN) adults enrolled in a clinical trial of an alcohol intervention. Among 326 parent participants, 40% reported ever having a child removed from their care in part because of the parent’s alcohol use, defined here as alcohol-related child removal. Seventy-five percent of parents reported at least one separation during their own childhood (M = 1.3, SD = 1.0). In a multivariable analysis, alcohol-related child removal was associated with parental boarding school attendance. No relationship was found between alcohol-related child removal and alcohol intervention outcomes. Results may provide evidence of multigenerational child removal impacts of boarding schools on AI/AN adults receiving an alcohol use disorder intervention. Assessment of parental history of child removal by practitioners, strategies to prevent alcohol-related separation and to support reunification should be integrated into addiction treatment in AI/AN communities.
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Sa’ah Naaghái Bik’eh Hózhóón (SNBH) is Diné epistemology, a complex system of knowledge encompassing two paradigms: Beauty Way (Hózhóójii-female) and Protection Way (Naayée’ k’egho-male), with hózhó at its core. The study examines personal narratives of SNBH through lived experiences toward hózhó. The literature review looks at Diné worldview from the perspective of published Diné scholars on SNBH for Diné youth. This qualitative case study approach, using Indigenous epistemology and Indigenous research methodology framework, allowed for intensive descriptions and analysis of SNBH. The interviews explored participants’ lived experiences using narrative inquiry to understand SNBH. The findings suggest that there is a significant relationship between SNBH—when interpreted through storytelling—and transformative awakening that could lead to new understanding of responsibility and purpose in the lives of Diné youth. The author concludes that more research is needed on Diné epistemology to develop Diné -centered educational frameworks on transformative pedagogical practices for mindfulness using principles of hózhó.
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LGBTQ+ stories and histories have long been silenced as part of deliberate work by those in power to erase our identities and experiences. As evaluators, we contribute to the process of either silencing or uplifting LGBTQ+ stories. This aspect of our work begs a number of vital questions that each of us must reckon with when we approach an evaluation: What data are necessary to allow us to tell a story? What story will we tell with the data we have collected? And, most importantly, who does the telling of certain stories benefit, who might it harm, and what is our responsibility as evaluators to protect peoples’ stories? Proceeding from these questions, this chapter has three distinct parts. In Part One, we establish a common language. By integrating perspectives from the social sciences and LGBTQ+ community scholarship, we provide an overview of the complex and contextually specific nature of sex, sexual orientation, and gender, and discuss the implications of these complexities on how we approach collecting LGBTQ+ data. In Part Two, we consider the power of the stories we tell to impact the lives of LGBTQ+ people, and the frameworks, theories, and ethical imperatives which may help us to contribute to a narrative of LGBTQ+ liberation through our work. Finally, in Part Three, we offer an example tool for readers to use as they consider how they would approach this work in their own practices.
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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.
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Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents’ ACEs on children’s outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children’s outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children’s outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018–2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children’s outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children’s outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.
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Substance use has been identified by Indigenous populations as contributing to health disparities facing their communities. Rates of trauma exposure and post-traumatic stress disorder are higher in Indigenous, compared to non-Indigenous, populations and have been linked to substance use. Historical trauma is thought to be one mechanism underlying substance use and related disorders. The purpose of the present study is to summarize the current state of the literature focusing on the association between trauma (historical and lived) and substance use among Indigenous populations in the United States and Canada. Databases were systematically searched using the preferred reporting items for systematic reviews and meta-analyses statement. The search strategy initially yielded 4,026 articles. After exclusion of ineligible articles, 63 articles remained for synthesis. Results of the present review provide evidence for a positive link between substance use and both historical trauma (i.e., 86.4% of studies) and lived trauma (i.e., 84.7% of studies). Indigenous participants reported that historical trauma and pain related to loss of cultural identity contributed to substance use in their communities. Indigenous participants also consistently described an association between lived trauma and substance use. Despite heterogeneity among Indigenous communities, findings suggest a significant association between trauma and substance use across many different tribes and settings (e.g., reservation/reserve, rural/urban). Indigenous participants identified healing from trauma and reconnecting with culture as necessary components for reducing substance use and maintaining sobriety. With this, the development and implementation of interventions should partner with Indigenous communities in a manner that promotes and enhances cultural values for healing.
Article
Introduction American Indian/Alaska Native (AIAN) communities experience a disproportionate number of violent crimes compared with other populations. Tribal-based services for victims are lacking on smaller reservations. A needs assessment was conducted for a tribe in the Pacific Northwest addressing this issue. Method Utilizing a framework of community-based participatory research (CBPR), a survey study was conducted with tribal members and local service providers. Survey A was composed of questions constructed by a tribal working group and Survey B questions were from an existing survey. Results Tribal members ( n = 5) indicated violence was experienced by all and witnessed by 80% of participants. Service providers ( n = 17) perceived adequate but underutilization of resources. Discussion The presence of violence in the community was confirmed. Services were not routinely accessed by members. Service providers indicated knowledge gaps in the community and cultural barriers for AIAN people. The study raised awareness of violence in AIAN communities and need for additional research.
Article
To date, little to nothing is known about Native Hawaiian and Pacific Islander (NHPI) children in foster care although they are overrepresented in some of the child welfare systems in the United States and experience challenges stemming from structural colonialism and displacement. To highlight this often-overlooked population in child welfare research, the current study applied an indigenous model to understand who the NHPI children are in foster care by descriptively examining their sociodemographic, family of origin and geographic characteristics, as well as their placement status with relatives or foster parents who identify as NHPI. Data came from the Adoption and Foster Care Analysis Reporting System with a focus on the 2018 entry cohort (N = 763). One-way analysis of variance and chi-square analysis were used. Results showed that NHPI children in foster care were school aged, most commonly entered foster care due to neglect, and were most likely to be placed with relatives. Non-relative foster parents were more likely than relative foster parents to care for NHPI children with disabilities, sexual abuse histories, and parental incarceration. Within non-relative foster families, those where at least one foster parent identified as NHPI were more likely to care for NHPI children with behavior problems or parental illness, compared to non-relative foster families where no foster parent identified as NHPI. NHPI children in relative foster families experienced the least placement disruptions, but relative foster families tended to be more socioeconomically disadvantaged and a smaller proportion of them received monthly foster care payments than non-relative foster families. The results suggest that child welfare practitioners and policymakers should prioritize financially supporting relatives as part of ensuring NHPI children’s wellbeing and preserving their connections to family and culture.
Article
This article highlights the limitations of culturally relevant care for Indigenous people in the prevention, treatment, and recovery of substance use disorders. It provides recommendations for consideration that expand the capacity for cultural humility. The “one-size-fits-all” approach to providing services, employed by most health and human service providers who are non-Indigenous, has failed. These limitations are often because of a lack of understanding of the larger historical and cultural context of Indigenous people. The authors emphasize the importance of health and human service providers' acquisition of the requisite knowledge about the impact of colonization and trauma that guides a trauma-informed approach to treatment. Sixteen suggestions are provided to serve as a guide when serving Indigenous populations. They include expanding the body of literature on evidence-based practices to include the voice of Indigenous populations through the application of a Community-Based Participatory Action Research approach. Critical to achieving these outcomes is an expansion of the number of behavioral health providers who are Indigenous through the adoption of pedagogical practices that better serve the educational needs of this population. In addition, expanding the capacity of the preservice workforce to understand the impact of colonialization and cultural genocide is paramount. The goal is to prevent the perpetuation of negative attitudes and beliefs that result in addiction treatment providers becoming frustrated with the outcome and blaming the patient. These suggestions, based on the literature, will maximize positive outcomes and can be adapted by a broad spectrum of providers of substance use disorder services.
Article
Objectives Native Hawaiians (NH) report higher rates of interpersonal trauma in childhood or adolescence (ITCA) as well as higher rates of chronic physical illness and psychopathology. Given that physical activity (PA) has positive impacts on physical and mental health, it may also serve as a protective factor in the development of poor health outcomes in adulthood following ITCA. The present study investigated what factors contribute to wellbeing and transdiagnostic posttraumatic sequelae for individuals with exposure to ITCA using a dataset from a longitudinal study cohort (n = 989) of ethnically diverse older individuals (mean age = 60) in Hawaiʻi. Methods Five univariate general linear models were used to explore the unique effects of: PA; ITCA level; NH status; interactions with ITCA level; and interactions with NH status on the dependent variables: posttraumatic sequelae (i.e., dissociation, avoidance, interpersonal difficulty) and aspects of wellbeing (i.e., satisfaction with life [SWL], self-rated health). Results PA was a significant predictor of SWL, self-rated health, and dissociation, while exposure to ITCA predicted SWL. NH group status interacted with PA to uniquely predict dissociation. Exposure to ITCA differentially predicted SWL. Conclusions Findings support prior evidence that processes in posttraumatic experience are significantly associated with poor health-promoting behaviors (e.g., PA). Additionally, for NHs, PA may reduce dissociation, or levels of dissociation already present in the NH group may play a role in disengagement from PA. Future research should consider whether PA holds benefits across trauma types (e.g., historical trauma), or if culturally based PA is differentially more protective.
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Over the past 20 years, collaboration has become an essential aspect of archaeological practice in North America. In paying increased attention to the voices of descendant and local communities, archaeologists have become aware of the persistent injustices these often marginalized groups face. Building on growing calls for a responsive and engaged cultural heritage praxis, this forum article brings together a group of Native and non-Native scholars working at the nexus of history, ethnography, archaeology, and law in order to grapple with the role of archaeology in advancing social justice. Contributors to this article touch on a diverse range of critical issues facing Indigenous communities in the United States, including heritage law, decolonization, foodways, community-based participatory research, and pedagogy. Uniting these commentaries is a shared emphasis on research practices that promote Indigenous sovereignty and self-determination. In drawing these case studies together, we articulate a sovereignty-based model of social justice that facilitates Indigenous control over cultural heritage in ways that address their contemporary needs and goals.
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The study took place in an indigenous Rukai community located in Pingtung, Taiwan. Participants included four male and four female upper-grade elementary students. The research uses a "community-based participatory research approach" that empowers local indigenous knowledge holders to formulate and develop education. With their help and guidance, the research team developed a year-long STEM curriculum centered on the Rukai's traditional ecological knowledge (TEK) of water to promote the ethnic identity of indigenous students and to understand its development. The research team identified three stages of the development of ethnic identity: initial, moratorium and achieved stages. The nature of ethnic identity can be described in terms of its “internal construction” and “external manifestation,” which consisted of six dimensions, and findings confirmed that these students developed their internal construction and external manifestation of ethnic identity. The curriculum began with an exploration of the Rukai community and established values and beliefs regarding Rukai. Eventually, the students formed a high level of commitment and sense of belonging and positive evaluation and ethnic attitudes and ethnic behaviors related to the Rukai group. This study hopes to develop, through the course outlined here, a method for students to cultivate a deep understanding of Rukai culture and identity. This understanding plays a vital role in the future continuity of the language, culture and ecological knowledge of their hometown and ethnic group, and in realizing the vision of sustainable nature and culture.
Article
Purpose The purpose of the current study is to conduct a systematic review of peer-reviewed work on culturally tailored interventions for alcohol and drug use in Indigenous adults in North America. Substance use has been reported as a health concern for many Indigenous communities. Indigenous groups experienced the highest drug overdose death rates in 2015, the largest percentage increase in the number of deaths over time from 1999 to 2015 compared to any other racial group. However, few Indigenous individuals report participating in treatment for alcohol or drug use, which may reflect the limited engagement that Indigenous groups have with treatment options that are accessible, effective and culturally integrative. Design/methodology/approach Electronic searches were conducted from 2000 to April 21, 2021, using PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed. Two reviewers classified abstracts for study inclusion, resulting in 18 studies. Findings Most studies were conducted in the USA (89%). Interventions were largely implemented in Tribal/rural settings (61%), with a minority implemented in both Tribal and urban contexts (11%). Study samples ranged from 4 to 742 clients. Interventions were most often conducted in residential treatment settings (39%). Only one (6%) intervention focused on opioid use among Indigenous people. Most interventions addressed the use of both drugs and alcohol (72%), with only three (17%) interventions specifically intended to reduce alcohol use. Originality/value The results of this research lend insight into the characteristics of culturally integrative treatment options for Indigenous groups and highlight the need for increased investment in research related to culturally tailored treatment across the diverse landscape of Indigenous populations.
Chapter
When we think about a psychodynamic formulation, we generally think about how person's relationships and life story have affected the development of their unique problems and patterns. People are born with a unique endowment that influences the way their relationships and environment affects them. This chapter considers the impact of this unique endowment when we think about the psychodynamic formulation. We can think of this endowment as everything we bring into the world at birth. It includes contributions from genetics and heredity; prenatal development, including the mother's physical and emotional health during pregnancy; peripartum events; and transgenerational transmission of trauma. The chapter reviews some of the ways the prenatal and peripartum periods contribute to adult development. It defines two types of types of heredity: genetic inheritance and epigenetic inheritance. Twin, adoption, and family studies have supported a role for heredity in many psychiatric disorders, including mood and anxiety disorders, psychotic illnesses, and autism.
Article
Previous research on the risk factors for the development of mental health disorders among Indigenous Peoples in the United States suggest that experiencing prejudice is correlated with the development of psychopathology. However, the relation between school‐based prejudice, including microaggressions, and the development of depression remains unexamined. As such, the current study is an exploratory analysis among a small sample (N = 47) of age 18–25 Indigenous young adults from the American Northwest examining the predictive relation between their retrospective recall of school‐based racial microaggressions as measured by the School‐Based Racial and Ethnic Microaggressions Subscale and their current levels of depressive symptoms in adulthood as measured by the Center for Epidemiological Studies Depression Scale. There was a statistically significant predictive relation found between participant's retrospective recall of microaggressions and their current levels of depression as young adults. As such, the practice and policy implications for school‐based professionals are discussed. Native American young adults experience racial microaggressions in the high school setting. Native American young adults recall of racial microaggressions in the high school setting were predictive of their current levels of depression as young adults. As such, the authors believe that school mental health professionals have the duty to identify and dismantle systems that uphold colonialism and racism within school systems. Native American young adults experience racial microaggressions in the high school setting. Native American young adults recall of racial microaggressions in the high school setting were predictive of their current levels of depression as young adults. As such, the authors believe that school mental health professionals have the duty to identify and dismantle systems that uphold colonialism and racism within school systems.
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Introduction Mental health disorders (MHDs) and substance use disorders (SUDs) in people living with HIV, hepatitis C virus (HCV) infection, and HIV/HCV coinfection are common and result in significant morbidity. However, there are no national prevalence estimates of these comorbidities in American Indian and Alaska Native (AI/AN) adults with HIV, HCV infection, or HIV/HCV coinfection. This study estimates the prevalence of MHD and SUD diagnoses in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection within the Indian Health Service (IHS). Methods In 2021, a cross-sectional study using data from the National Patient Information Reporting System was completed to identify MHD or SUD diagnoses in AI/AN adults with HIV, HCV infection, or HIV/HCV coinfection within the IHS during fiscal years 2001‒2020. Logistic regression was used to compare the odds of MHD or SUD diagnoses, adjusting for age and sex. Results Of AI/AN adults diagnosed with HIV, hepatitis C virus infection, or HIV/HCV coinfection, the period prevalence of MHD or SUD diagnoses ranged from 57.2% to 81.1%. Adjusting for age and sex, individuals with HCV infection had higher odds of receiving a MHD diagnosis (AOR=1.57; 95% CI=1.47, 1.68) or SUD diagnosis (AOR=3.40; 95% CI=3.18, 3.65) than those with HIV, and individuals with HIV/HCV coinfection had higher odds of receiving a MHD diagnosis (AOR=1.60; 95% CI=1.35, 1.89) or SUD diagnosis (AOR=2.81; 95% CI=2.32, 3.41) than those with HIV. Conclusions MHD and SUD diagnoses were common in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection, highlighting the need for culturally appropriate screening and treatment programs sensitive to the diverse strengths of AI/AN populations and structural challenges they endure.
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It was almost two decades ago that the authors became aware of the concept of a “soul wound,” although knowledge of what is characterized as the “soul wound” had been an integral part of indigenous knowledge ever since Columbus landed in this hemisphere and Cortez arrived in Vera Cruz, Mexico. Native people who were asked about problems in the contemporary Native community explained that present problems had their etiology in the traumatic events known as the “soul wound” Knowledge of the soul wound has been present in Indian country for many generations. Current synonymous terms include historical trauma (Brave Heart, in press a), historical legacy, American Indian holocaust, and intergenerational posttraumatic stress disorder (Brave Heart & De Brun, in press). In addition, there has been academic literature documenting the American Indian holocaust, thus bringing some validation to the feelings of a community that has not had the world acknowledge the systematic genocide perpetrated on it (Brave Heart-Jordan & DeBruyn, 1995; Brown, 1971; Legters, 1988; Stannard, 1992; Thornton, 1987).
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Around 1982, thousands of Guatemalan Mayas fled their villagesand lands to escape the Ros Montt scorched-earth policyimplemented in rural areas. After more than a decade of exile,many of those refugees have returned to their homeland. Thispaper looks at the ways in which young Mayan refugees who havereturned home after extended exile in Mexico appropriate anddistance themselves from the collective project of going home. Two Mayan communities of retornados (returnees), whose paths into exile and home again differ slightly, are compared. Outsidesupport from international organizations and cohesion in therefugee camps enabled the young people of La Victoria to seedisclosure of the traumatic past from a position of strength andconfrontation as the key to social change. In La Esperanza, thepast is rebuilt by the youth around avoidance of recent history,and tradition appears as a bridge between past and future. Theway the youth of the two communities construct their homecomingdemonstrates how small changes in the migration experience mayresult in considerable differences in the choice of strategies,and raises important questions about assistance programs thatmight be developed for these populations.
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Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.
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Racial/ethnic minority populations are underserved in the American mental health care system. Disparity in treatment between whites and African Americans has increased substantially since the 1990s. Racial/ethnic minorities may be disproportionately affected by limited English proficiency, remote geographic settings, stigma, fragmented services, cost, comorbidity of mental illness and chronic diseases, cultural understanding of health care services, and incarceration. We present a model that illustrates how social determinants of health, interventions, and outcomes interact to affect mental health and mental illness. Public health approaches to these concerns include preventive strategies and federal agency collaborations that optimize the resilience of racial/ethnic minorities. We recommend strategies such as enhanced surveillance, research, evidence-based practice, and public policies that set standards for tracking and reducing disparities.
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Rituales, comunión social, silencio, emociones y demandas de Memoria Colectiva en el caso del genocidio Guatemalteco. Este artículo examina la teoría y los datos sobre los efectos emocionales de los procesos de memoria colectiva como los rituales funerarios y la comunión social. Los análisis empíricos se basan en la experiencia de los Mayas Guatemaltecos, quienes fueron víctimas de un genocidio durante la década 1980-1990. Los resultados muestran que los Mayas no declaran menos reacciones emocionales y subjetivas en comparación con los guatemaltecos ladinos. Esto contradice la idea que los Mayas comparten una cultura menos expresiva y emocional. Los rituales tienen un efecto amortiguador más importante para los Mayas que para los Ladinos. Las perdidas materiales han golpeado y afectado a ambas comunidades, ladinos y mayas, de forma diferente. Las actividades de conmemoración fueron más importantes en el caso de personas que vivieron masacres colectivas. El silencio fue una forma de afrontamiento adaptativa, aunque puede no serlo en el momento actual
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This study investigated the effects of gender, number of lifetime psychiatric diagnoses, and childhood victimization on utilization of mental health and substance abuse treatment services in a Southwestern American Indian tribe. A total of 582 individuals were recruited based on tribal enrollment and membership in large multigenerational pedigrees. Subjects were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, a semistructured psychiatric interview. For this study the definition of childhood victimization was limited to childhood sexual abuse. Fifty-six percent of the subjects had received mental health treatment, substance abuse treatment, or both. Patterns of service utilization differed by gender with the odds of inpatient and substance abuse treatment higher for men than for women. Women were more likely than men to receive mental health treatment. Subjects who had been sexually abused as children were more likely to have three or more psychiatric diagnoses and to have received extensive treatment, compared with subjects who reported no childhood sexual abuse history. Logistic regression demonstrated strong relationships between number of psychiatric diagnoses and the likelihood of treatment among both men and women. Gender, number of psychiatric diagnoses, and childhood sexual abuse are strong predictors of utilization of mental health and substance abuse treatment services. These factors should be considered in designing treatment interventions.
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High rates of violence and trauma in many American Indian communities have been reported. The authors investigated the relationship between both the frequency and type of traumatic events and the prevalence of posttraumatic stress disorder (PTSD) in a Southwestern American Indian tribe. A structured psychiatric interview and the Traumatic Events Booklet were administered to a subset of 247 tribal members from an overall study population of 582. Subjects were recruited from the community on the basis of membership in pedigrees, and not by convenience. DSM-III-R diagnoses were assigned by consensus after the interviews were evaluated blindly by independent raters. The prevalence of lifetime PTSD was 21.9% (N = 54), and 81.4% of the subjects (N = 201) had experienced at least one traumatic event apiece. The most predictive factor for lifetime PTSD among women was the experience of physical assault, and for men the most predictive factors were a history of combat and having experienced more than 10 traumatic events. In this Southwestern American Indian community, the prevalences of lifetime PTSD and of exposure to a traumatic event were higher than in the general U.S. population. However, the nearly 4:1 ratio of subjects who reported at least one traumatic event to those with PTSD diagnoses is similar to findings from studies of non-Indians. Individuals with a history of multiple traumatic events (66.0%, N = 163) had a significantly higher risk of developing PTSD. Chronic and multiple trauma did not preclude the identification of acute and discrete traumatic events that resulted in PTSD.
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The historical trauma response is a constellation of characteristics associated with massive cumulative group trauma across generations, similar to those found among Jewish Holocaust survivors and descendants. Trauma response features include elevated mortality rates and health problems emanating from heart disease, hypertension, alcohol abuse, and suicidal behavior. This article explores gender differences in the historical trauma response among the Lakota (Teton Sioux) and the correlation with health and mental health statistics. The theory of a Lakota historical trauma response is first explained. Traditional gender roles are described in combination with modifications engendered by traumatic Lakota history. Then, data from a study on Lakota historical trauma are presented, including gender differences in response to an experimental intervention aimed at facilitating a trauma resolution process. The data revealed significant gender differences. The sample of women presented initially with a greater degree of conscious affective experience of historical trauma. In contrast, the men reported more lifespan trauma associated with boarding school attendance and appeared to be at an earlier stage of grief. However, at the end of the intervention, women's experience of survivor guilt--a significant trauma response feature-decreased while men's consciousness of historical trauma and unresolved grief increased. Degree of traditional presentation-of-self, including phenotype, appeared to interact with gender to place male participants at greater risk for being traumatized over the lifespan and perhaps subsequently utilizing more rigid defenses against the conscious experience of the trauma with the exception of survivor guilt. The article concludes with a discussion of health and mental health implications for prevention and treatment of the trauma response which could positively impact the health status of the Lakota. Recommendations for future research are suggested.
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American Indian adults are thought to experience significant depressive symptoms at rates several times higher than adults in the general population, yet we know very little about factors associated with depressive symptoms among this under studied group. Many researchers have argued that depressive symptoms are associated with conflicts between American Indian traditional cultural values, practices, and beliefs and those of the majority culture. This report, based on a sample 287 American Indian adults from the upper Midwest, takes into account two measures of cultural effects: perceived discrimination, as one indicator of culture conflict, and traditional practices, as a measure of cultural identification. The results indicate that discrimination is strongly associated with depressive symptoms among American Indian adults and that engaging in traditional practices is negatively related to depressive symptoms. Moreover, interaction effects between perceived discrimination and traditional practices indicate that engaging in traditional practices buffers the negative effects of discrimination among those who regularly participate in them.
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From 1981 to 2001, 46 000 refugees who fled the 36-year civil conflict in Guatemala for Chiapas, Mexico were under the protection of the United Nations High Commissioner for Refugees. To estimate the prevalence of mental illness and factors associated with poor mental health of underserved Guatemalan refugee communities located in Chiapas, Mexico, since 1981 and to assess need for mental health services. Cross-sectional survey of 183 households in 5 Mayan refugee camps in Chiapas representing an estimated 1546 residents (adults and children) conducted November-December 2000. Symptom criteria of Posttraumatic Stress Disorder (PTSD), anxiety, and depression as measured by the Harvard Trauma Questionnaire and Hopkins Symptom Checklist-25 (Hopkins-25). One adult (aged > or =16 years) per household (n = 170 respondents) who agreed to participate was included in the analysis, representing an estimated 93% of households. All respondents reported experiencing at least 1 traumatic event with a mean of 8.3 traumatic events per individual. Of the respondents, 20 (11.8%) had all symptom criteria for PTSD. Of the 160 who completed the Hopkins Symptom Checklist-25, 87 (54.4%) had anxiety symptoms and 62 (38.8%) had symptoms of depression. Witnessing the disappearance of family members (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.35-15.50), being close to death (AOR, 4.19, 95% CI, 1.03-17.00), or living with 9 to 15 persons in the same home (AOR, 3.69; 95% CI, 1.19-11.39) were associated with symptoms of PTSD. There was a protective factor found for lacking sufficient food (AOR, 0.08; 95% CI, 0.01-0.59). Elevated anxiety symptoms were associated with witnessing a massacre (AOR, 10.63; 95% CI, 4.31-26.22), being wounded (AOR, 3.22; 95% CI, 0.95-10.89), and experiencing 7 to 12 traumatic events (AOR, 2.67; 95% CI, 1.14-6.27) and 13 to 19 traumatic events (AOR, 2.26; 95% CI, 0.65-7.89). Elevated symptoms of depression were associated with being a woman (AOR, 3.64; 95% CI, 1.47-9.04), being widowed (AOR, 27.55; 95% CI, 2.54-299.27), being married (AOR, 1.93; 95% CI, 0.59-6.33), witnessing disappearances (AOR, 2.68; 95% CI, 1.16-6.19), experiencing 7 to 12 traumatic events (AOR, 1.57; 95% CI, 0.64-3.88), or experiencing 13 to 19 traumatic events (AOR, 7.44; 95% CI, 2.18-25.37). Psychiatric morbidity related to human rights violations, traumatic events, and refugee status was common among Guatemalan refugees surveyed 20 years after the Guatemalan civil conflict.
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This article reports on the development of two measures relating to historical trauma among American Indian people: The Historical Loss Scale and The Historical Loss Associated Symptoms Scale. Measurement characteristics including frequencies, internal reliability, and confirmatory factor analyses were calculated based on 143 American Indian adult parents of children aged 10 through 12 years who are part of an ongoing longitudinal study of American Indian families in the upper Midwest. Results indicate both scales have high internal reliability. Frequencies indicate that the current generation of American Indian adults have frequent thoughts pertaining to historical losses and that they associate these losses with negative feelings. Two factors of the Historical Loss Associated Symptoms Scale indicate one anxiety/depression component and one anger/avoidance component. The results are discussed in terms of future research and theory pertaining to historical trauma among American Indian people.
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Many tribal and urban American Indians and Alaska Native communities have initiated HIV/AIDS prevention and treatment services. The richness, depth, and scope of these efforts, however, are not well known and have not been sufficiently documented in the academic literature. In this article we assess the strengths and weakness of the published literature using the constructs of the socioecological framework. We discuss the need to apply an "indigenist" etiology paradigm to HIV/AIDS risk and protection. Finally, we define and discuss the varied postcolonial approaches to HIV/AIDS prevention, treatment, and healing.
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Traditional indigenous healing is widely used today, as it has been since time immemorial. This article describes the following areas in regards to traditional healing: (a) an explanation of indigenous peoples, (b) a definition of traditional indigenous healing, (c) a portrayal of traditional healers, (d) health within indigenous culture, (e) traditional healing techniques, (f) utilization of traditional healing, (g) how to find a traditional healer, and (h) comparing traditional healing principles with mainstream ways. It is important to have knowledge about this method of holistic healing so health care providers and nurses can integrate it into the health care for individuals and/or families that choose traditional indigenous healing.
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This report investigates the effects of discrimination, historical loss and enculturation on meeting diagnostic criteria for 12-month alcohol abuse among American Indians who share a common culture in the upper Midwest. We introduce an empirical measure of historical loss and hypothesize that historical loss will mediate the effects of discrimination on meeting 12-month diagnostic criteria for alcohol abuse. We also hypothesize that enculturation will be negatively associated with 12-month alcohol abuse and mediate or moderate the effects of discrimination. A sample of 452 (351 women) American-Indian parents/caretakers (mean age: women = 39 years, men = 42 years) of children ages 10 to 12 years participated in diagnostic interviews for lifetime and 12-month alcohol abuse. The subjects' perceptions of discrimination, historical loss and enculturation were also measured. Structural equation modeling was used to evaluate direct and potential mediating effects of latent constructs of enculturation (a resiliency factor) and historical loss (a risk factor) on the relationship between discrimination and meeting criteria for 12-month alcohol abuse. Historical loss mediated the effects of discrimination on 12-month alcohol abuse among women. Enculturation neither mediated nor moderated the effects of discrimination but had an independent negative effect on alcohol abuse. In a combined model comprising both enculturation and historical loss, the effects of discrimination on 12-month alcohol abuse were mediated. This study presents important new evidence that historical loss affects American-Indian alcohol abuse. It also provides evidence for the resiliency effects of enculturation on alcohol abuse.
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We examined the prevalence of trauma in 2 large American Indian communities in an attempt to describe demographic correlates and to compare findings with a representative sample of the US population. We determined differences in exposure to each of 16 types of trauma among 3084 tribal members aged 15 to 57 years through structured interviews. We compared prevalence rates of trauma, by gender, across the 2 tribes and with a sample of the US general population. We used logistic regression analyses to examine the relationships of demographic correlates to trauma exposure. Lifetime exposure rates to at least 1 trauma (62.4%-67.2% among male participants, 66.2%-69.8% among female participants) fell at the upper limits of the range reported by other researchers. Unlike the US general population, female and male American Indians exhibited equivalent levels of overall trauma exposure. Members of both tribes more often witnessed traumatic events, experienced traumas to loved ones, and were victims of physical attacks than their counterparts in the overall US population. American Indians live in adverse environments that place them at high risk for exposure to trauma and harmful health sequelae.
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The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) provided estimates of the prevalence of DSM-III-R disorders and utilization of services for help with those disorders in American Indian populations. Completed between 1997 and 1999, the AI-SUPERPFP was designed to allow comparison of findings with the results of the baseline National Comorbidity Survey (NCS), conducted in 1990-1992, which reflected the general United States population. A total of 3,084 tribal members (1,446 in a Southwest tribe and 1,638 in a Northern Plains tribe) age 15-54 years living on or near their home reservations were interviewed with an adaptation of the University of Michigan Composite International Diagnostic Interview. The lifetime and 12-month prevalences of nine DSM-III-R disorders were estimated, and patterns of help-seeking for symptoms of mental disorders were examined. The most common lifetime diagnoses in the American Indian populations were alcohol dependence, posttraumatic stress disorder (PTSD), and major depressive episode. Compared with NCS results, lifetime PTSD rates were higher in all American Indian samples, lifetime alcohol dependence rates were higher for all but Southwest women, and lifetime major depressive episode rates were lower for Northern Plains men and women. Fewer disparities for 12-month rates emerged. After differences in demographic variables were accounted for, both American Indian samples were at heightened risk for PTSD and alcohol dependence but at lower risk for major depressive episode, compared with the NCS sample. American Indian men were more likely than those in NCS to seek help for substance use problems from specialty providers; American Indian women were less likely to talk to nonspecialty providers about emotional problems. Help-seeking from traditional healers was common in both American Indian populations and was especially common in the Southwest. The results suggest that these American Indian populations had comparable, and in some cases greater, mental health service needs, compared with the general population of the United States.
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Among American Indian and Alaska Native (AIAN) people, the concept of mental illness has different meanings and is interpreted in various ways. This paper describes the realities of mental health care that confront AIAN people. Stigma is associated with mental illness, which can be a barrier for those individuals who are in need of mental health services. Within the context of the AIAN historical and contemporary experiences, the paper details domains that negatively influence the lives of AIAN people. Included are the failure of the U.S. government to fulfill its treaty agreements with AIAN people; the disparities in income and education, and the pervasiveness of poverty; and access to care issues. These domains help to set the stage for health disparities that frequently catapult AIAN people to early morbidity and mortality. Importantly, many of these conditions are preventable. The paper concludes with recommendations for a more diverse workforce that will include AIAN mental health professionals who are available to provide culturally competent care to AIAN people in a variety of settings.
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The pursuit of evidence-based practice (EBP) within the mental health professions has contributed to efficacious clinical intervention for individuals struggling with mental health problems. Within the context of the EBP movement, this article reviews the treatment outcome literature for mental health interventions directed specifically toward American Indians and Alaska Natives experiencing psychological distress. Fifty-six articles and chapters pertaining to the treatment of Native Americans with mental health problems were identified, though the vast majority of these did not systematically assess outcomes of specified treatments for Native American clients under scientifically controlled conditions. Of just nine studies assessing intervention outcomes, only two were controlled studies with adequate sample sizes and interpretable results relative to the identification of EBP among American Indians and Alaska Natives. The advantages and limitations of EBP for treatment of Native American mental health problems are discussed.
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Au Guatemala, la peur, la suspicion et la paranoia resultent de l'impunite et sont aussi des moyens pour la maintenir. « La Violencia » comprend a la fois la violence visible et invisible. Les morts, les disparitions augmentent la conscience de la vulnerabilite de la population psychologiquement reprimee.
This article presents evidence to suggest that historical trauma has affected Lakota parents and children by changing parenting behavior and placing children at risk for alcohol and other substance abuse. The theoretical explanation of the Lakota historical trauma response is described and used as a framework for the design of a parenting skills curriculum. This intervention focuses on (1) facilitating parental awareness of life span and communal trauma across generations and (2) a re-cathexis or re-attachment to traditional Lakota values.The experimental curriculum intervention was delivered to a group of ten Lakota parents and two Lakota parent facilitators on a Lakota reservation. Qualitative study results revealed that parents experienced the curriculum as effective, particularly the focus on both historical trauma and the reconnection with traditional Lakota mores. The curriculum's emphasis on traditional protective factors for alcohol and other substance abuse prevention for Lakota children presents implications for other parenting curricula. The article concludes with recommendations for future research in the area of Indian parenting and historical trauma.
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Examines American-Indian adolescents' perceptions of risk factors and effects associated with alcohol use during pregnancy, and age-related prevention strategies for fetal alcohol syndrome. Results indicate peer pressure, influences of adult drinking behaviors, stressful family environment, and acceptance of alcohol use in Indian community may be risk factors associated with alcohol use among American-Indian youth. Participants indicated lack of knowledge about drinking/fetal alcohol syndrome relationship. (Author/MKA)
Article
This article, based on research conducted with Lakota human service providers, concludes that the Lakota (Teton Sioux) suffer from impaired grief of an enduring and pervasive quality. Impaired grief results from massive cumulative trauma associated with such cataclysmic events as the assassination of Sitting Bull, the Wounded Knee Massacre, and the forced removal of Lakota children to boarding schools.The research studied a culturally syntonic four‐day psychoeducational intervention designed to initiate a grief resolution process for a group of 45 Lakota human service providers. The methodology included assessment at three intervals: (a)apre‐ and post‐test, utilizing a Lakota Grief Experience Questionnaire andthe semantic differential, (b) a self report evaluation instrument at the end of the intervention, and (c) a six‐week follow‐up questionnaire.The results confirmed the hypotheses that: (a) education about historical trauma would lead to increased awareness of the impact and associated grief related affects of the traumatic Lakota history, (b) sharing these affects with other Lakota in a traditional context would provide cathartic relief, and (c) grief resolution would be initiated, including a reduction in grief affects, more positive identity, and a commitment to individual and community healing.
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This article describes an investigation of ecological factors related to the experience of American Indian grandparents raising their grandchildren. Elements of American Indian culture and history, and United States policy, were used to generate explanatory hypotheses that were subjected to a thematic analysis of qualitative interview data. This approach was used to apply ecological theory and test the derived hypotheses. Results of the thematic analysis indicate that participants value maintenance of traditional culture in their efforts to parent their grandchildren. Support also emerged for the hypothesis that participants would evidence distrust of government and mainstream programs. The hypothesis that the assimilation policy and its use of boarding schools would increase participants' reluctance to access services encountered mixed results, but some participants expressed strong beliefs that this legacy is a contributing factor. The hypothesis that the Indian Child Welfare Act would facilitate participants' efforts to parent their grandchildren also met mixed results, but some clear descriptions of its effectiveness were offered.
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Discusses the current parenting difficulties of Native American clients who were formerly in residential schools. A connection is made between the abuse experienced by these individuals and their parental struggles. Along with addressing various sociopolitical issues, the article discusses a number of clinical interventions designed to promote the healing process of these victims and their families. They include parental engagement, family treatment, couple treatment, adult and child individual treatment, and political activism. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In recent times, psychosocial intervention activities by Native/Aboriginal traditional healers have received much attention. There is a belief among many Native Americans and Aboriginal Canadians that their current problems are connected to past and contemporary traumas and that psychology as a profession has failed them and is even perceived as an agent of social control and hegemony. As a result, more and more Aboriginal people are turning to traditional ways for psychological healing. In this study, Aboriginal healers and healer clients participated in individual interviews and discussions related to their experiences and views as to what conditions they believe are helpful in effecting positive changes in behavior, cognitions, and emotions. Through personal narratives and topical commentary, 12 therapeutic conditions were revealed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
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Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders.
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Indigenous people (American Indian/Alaska Natives; AI/AN) make up the smallest ethnic group in the United States comprising about 1.5% of the population (4.3 million people, Ogunwole, 2006), yet they rank higher in health disparities than any other ethnic group. The current life expectancy for an Indigenous person born today is nearly 5 years shorter than that of the general population (72.3 vs. 76.9 years). They are nearly six times more likely to die from alcoholism then are other Americans, five times more likely to die from tuberculosis, three times more likely to die from diabetes, and three times more likely to die from unintentional injuries, homicide or suicide (Indian Health Service, 1992) Indigenous children are more than twice as likely to die in the first 4 years of life than are other American children.
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Spanish-speaking individuals comprise a growing percentage of the United States population. They have greater difficulty than most in accessing and remaining in psychiatric treatments, including psychotherapy, their stated preference. The literature on cultural competence in treating Hispanic patients provides few details of psychotherapeutic adaptations. This article, based on interpersonal psychotherapy (IPT) supervision for a low-socioeconomic sample of monolingual Spanish-speaking New York City patients, describes culturally specific psychotherapy. In conducting IPT for Spanish-speaking patients with DSM-IV major depressive disorder, we reviewed cases in weekly supervision over 3 years (January 2005 to January 2008) to explore treatment themes and evaluate the congruence of IPT in addressing them. Important themes are illustrated by case example. Key themes include (1) the centrality of family, (2) conflicts due to migration and acculturation, (3) gender roles, (4) need to avoid humiliating or irrevocable social confrontation, and (5) equanimity in facing an unpredictable environment. IPT appears a compatible intervention, focusing on and adaptable to these important issues for Hispanic patients.
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In recent years psychologists and other mental health workers have begun to document the effects of state-sponsored violence and civil war on civilians and to develop specific clinical and community interventions to address these issues. During the past decade between 50,000 to 100,000 Guatemalans have been murdered and at least 38,000 people disappeared. Over 400 rural villages were destroyed and the Guatemalan army's scorched earth policy forced hundreds of thousands who survived to flee, either to another part of the country or to leave Guatemala altogether. State-sponsored terror and silencing persists in Guatemala despite a return to civilian government. This article describes some of the problems encountered by Maya children in situations of ongoing war and state-sponsored terror and the development of one specific response, Creative Workshops for Children, an international, interdisciplinary program organized by mental health workers from Argentina, Guatemala and United States.
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Culturally informed social work health and mental health interventions directed toward American Indian clients must be harmonious with their environment and acculturation. This article discusses American Indian beliefs about health and illness and degrees of acculturation. Guidelines are offered to help non-Indian social workers design culturally appropriate interventions.
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This paper describes a family-centered prevention intervention for preschool-aged children-the Indian Family Wellness (IFW) project. The development, implementation, and evaluation of IFW has been based upon a tribal participatory research model, an approach that emphasizes full participation of tribes and tribal members in all phases of the research process and incorporates cultural and historical factors vital to strengthening American Indian and Alaska Native families. We present four mechanisms of tribal participatory research, describe how they have been applied in the IFW project, and consider the implications of this work for the field of family-centered prevention research.
Article
Historical trauma (HT) is cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences; the historical trauma response (HTR) is the constellation of features in reaction to this trauma. The HTR often includes depression, self-destructive behavior, suicidal thoughts and gestures, anxiety, low self-esteem, anger, and difficulty recognizing and expressing emotions. It may include substance abuse, often an attempt to avoid painful feelings through self-medication. Historical unresolved grief is the associated affect that accompanies HTR; this grief may be considered fixated, impaired, delayed, and/or disenfranchised. This article will explain HT theory and the HTR, delineate the features of the HTR and its grounding in the literature, offer specific Native examples of HT and HTR, and will suggest ways to incorporate HT theory in treatment, research and evaluation. The article will conclude with implications for all massively traumatized populations.
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Suicide rates among American Indian youth in the United States are two to three times the national average. Risk factors for American Indian youth include depression, alcohol use, hopelessness and stress, and family conflict, abuse, poverty, and instability. In this descriptive study, the authors aimed to obtain parents' and elders' perspectives on community needs and to identify strengths on which the community might build to reduce youth suicide risk. Data were collected from focus groups with 40 American Indian parents and from individual interviews with 9 American Indian elders. The major task participants addressed was holding the family together and healing intergenerational pains. Topics parents discussed were holding onto cultural values, holding the family together, getting through school, and getting a job. These findings substantiate previous research and provide useful information for the design of culturally appropriate family or community-based interventions to prevent American Indian youth suicide.
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Providing culturally sensitive psychiatric-mental health nursing care to Native Americans requires a unique set of understandings. Traditional tribal customs and beliefs, historical events of the past 500 years, and acculturation and enculturation have affected Native Americans' health and well-being. In 2004, I had the opportunity to practice as a psychiatric-mental health nurse practitioner with a Native American tribe in the southwestern United States. This article describes the lessons I learned while practicing on the reservation and suggests ways other non-Native American practitioners can best serve this population.
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Over multiple generations, American Indian communities have endured a succession of traumatic events that have enduring consequences for community members. This article presents a multilevel framework for exploring the impact of historically traumatic events on individuals, families, and communities. The critical connection between historically traumatic events and contemporary stressors is also discussed at length.
Trails of tears, and hope
  • S Abadian
The return to the sacred path: Healing the historical trauma response among the Lakota
  • Brave Heart
Long rides across the plains: Ft. Berthold students at Hampton Institute
  • M L Hultgren
  • P Fairbanks
Prevalence and characteristics of trauma and posttraumatic stress disorder in a southwestern American Indian community
  • R Robin
  • B Chester
  • J Rasmussen
  • J Jaranson
  • D Goldman