1 St Art Therapy World Congress

1 st Art Therapy World Congress Budapest Hungary; 30 March-April 2, 2003 Paper no. 187, Session 111. Afternoon, April 1, 2003 CREATING HOPE: ART AND THERAPY WITH SUICIDAL FIRST NATIONS YOUTH

Peggy Clarkson, M.A. ATR, RCC, RCAT Registered Art Therapist and Registered Clinical Counsellor General Delivery, Waglisla, British Columbia. VOT 1ZO Canada

[email protected]

This paper is a brief summary of a more comprehensive paper.

Summary Outline 1) Sacred Space: West Coast of British Columbia Canada

2) Intercultural Art Therapy 3) Loss: the primary theme in suicide 4) Aboriginal Youth Suicide 5) Healing from Loss with Meaning 6) Creating Hope

Abstract This paper will introduce the topic of First Nations youth suicide from the perspective of a West Coast Canadian Registered Clinical Counselor and Registered Art Therapist. Our goal in treatment is to enhance the courage and hope to live, within the face of demonstrating the courage to die. The author's intention is to educate clinicians and increase awareness of the multiple and complex factors which put First Nations youth at risk and differentiate assessment and treatment methodologies and modalities from other Non-Aboriginal populations. This includes art therapy treatment in rural, isolated communities from a perspective that includes history, family and community. The author posits that treatment will be enhanced by doing art and envisioning youth suicidal feelings and intent from a frame of multiple losses. Therefore, healing paradigms involve the development for the youth identity of multiple meaning within family, society and self.

"Aboriginal people are surrounded by death, whether it be from death in custody or death of our culture, and the death of our land or suicide within the Aboriginal community. Aboriginal people are not provided with answers, therefore reinforcing the feeling of powerlessness, which results in hopelessness and extreme turmoil. Many Aboriginal people turn their grief upon themselves, in that the experiences they and their families have undergone in the past have impacted upon them so heavily some have forgotten who they are, and some have never known." (1) SACRED SPACE

The West Coast of British Columbia has been home to First Nations families for over 10,000 years offering great linguistic and cultural diversity. It is a sacred land inspiring cultural meaning in art and life.

Intercultural Art therapy

Working inter culturally means: * a culturally respectful way of working with First Nations youth, and families * witnessing the culture * awareness of one’s limitations, gifts and stresses as a Non-Native worker * on-going learning local history from Elders and local, personal perspectives

In an interracial treatment context, we must be clear as we work within the "social origins of distress" (2) and historical ontology of suicidality for Aboriginal persons.

Identity is a rich area for therapy. Within identity there are common threads for Indigenous people in relation to the history of colonization and oppression, and its relation to personal oppression.

"There is no question that the high rates of suicide in the North and South are largely due to cultural genocide." (3)

Socio-historical commonalities contribute to specialized, culturally sensitive treatment with First Nations families: *a shared collective history of oppression and cultural loss *disproportionate exposure to violence, addictions & suicide *systemic removal of children or " cultural cleansing"(genocide) within the Indian Residential School system and boarding homes, resulting in the intergenerational cycles of abuse, parenting and cultural loss.

WHY ART THERAPY? - A CULTURAL FIT

Art is central to First Nations communities and culture. There is a cultural fit when introducing art therapy to First Nations families. For people who are depressed and suicidal, art can provide a less threatening intervention to "show" rather than "talk" about feelings. However, art can also be threatening and is not always the "best" intervention tool in certain circumstances.

There are many aspects within the use of art as therapy that lend themselves to working with Aboriginal youth and communities: * art and play are the languages of children and youth * art provides a window to "see oneself" not always available in verbal therapy * art provides "scapegoat transference" * the artistic process in the therapeutic space creates a "holding environment", creating safety both literal and psychological * art engages a journey into creativity and confidence, the client becoming an artist within their healing * art is a record of the therapeutic process over time * non-verbal therapy is helpful to those who have been "silenced" * art can provide a visual metaphor for healing and sublimation * artists have a high standing in First Nations society * artists are involved in traditional and healing ceremonies * the art therapist can offer complimentary skills and activities that dovetail with community healing strategies, cultural resurgence, re-defining traditional roles for youth * art in therapy allows for "dual processing": verbal and non-verbal

LOSS: THE PRIMARY THEME IN SUICIDE

"The loss of Aboriginal identity and the destruction of Aboriginal culture have contributed to a tremendous sense of loss within Indigenous communities." (4)

Loss is a prevalent theme among suicidal First Nations youth. Loss occurs on three basic levels: * Historical loss: i.e. residential school; cultural genocide; illness; language/ traditions/ parenting skills * Personal loss: i.e. family violence and disruption; substance abuse; complicated grief and mourning; socio-economic stress; abuse; childhood issues * Social loss: i.e. traditional roles in family and accompanying teachings; youth roles and responsibilities; "who am I"; identity formation; developmental tasks; conflict within two cultures

The idea of getting rid of the pain of loss is very helpful to discuss (and paint) with youth in terms of their habits and their suicidal state. Youth need to grieve both historical and current loss, and comprehend how their current choices to self-harm may be an attempt to deal with such losses.

ABORIGINAL YOUTH SUICIDE "Aboriginal rates of suicide remain disproportionately high compared with the general population, and this appears to be particularly pronounced among the youth". (5) WHAT IS SUICIDE?

Our goal in treatment is to enhance the courage and hope to live, while one is demonstrating the courage to die. How we define suicide impacts how we think about suicide and the families with whom we work. Here are two differing frames for defining suicide.

"Suicide is the final self-destructive act of despair, committed when a state of hopelessness and depression exists".(6)

The definition of suicidality proposed in this paper envisions healing from loss to meaning as follows: Suicidal thoughts and acts are courageous efforts to find inner peace, and end psychic chaos. They are repeated attempts to extinguish pain, isolation and despair in the face of multiple serious losses, trauma and lack of life meaning.

STAGES OF SUICIDALITY

"First Nations suicide rates are 70% higher than Non-Aboriginal rate..." (7)

Discern the stage of suicidality of the client in order to: a) assess safety and risk to harm self, b) create a treatment plan. The three stages of suicidality are: 1) pre-contemplative : thinking about death and dying 2) making a plan to end one's life 3) taking action to self-harm

ABORIGINAL YOUTH RISK FACTORS FOR SUICIDALITY

Risk factors, fully detailed in the comprehensive paper, fall into seven categories which may be used by clinicians as an informal risk assessment tool with Aboriginal youth: 1. Racial 2. Socioeconomic 3. Family/ Community 4. Psychiatric/ Dual Diagnosis 5. Historical/ Cultural 6. Geographical; Living on-Reserve 7. Age

THEORETICAL FRAMES: HEALING PARADIGMS An integrated approach to healing: I view suicide theory from several vantage points: 1)Philosophical 2) Clinical / psychodynamic/ behavioral 3) Aboriginal/ Traditional Spirit Medicine/ Wellness Wheel 4) Intergenerational Trauma 5) Non-Aboriginal

HEALING FROM LOSS WITH MEANING

"Generations had suffered, but the people are now a healing people." (8)

Multiple losses suggest multiple healing strategies. First Nations healing involves a web of change that is both within and external to the individual (psychological and social) but impacts the individual’s life meaning.

First Nations youth are at increased risk because while they are engaged in their primary developmental task to search for identity; they are also facing the multiple losses as previously described. Without meaning, they face the choice of death as a realistic option to the overwhelming equation of no identity within multiple losses.

CREATING HOPE

As the topic of suicide is multifarious, so is the diversity of applications of art within community and individual healing.

Chandler and Lalonde (1998) identified increased "self-continuity"(9) as a factor which decreased incidence of suicide amongst Aboriginal youth. "Communities that have taken active steps to preserve and rehabilitate their own cultures are shown to be those in which youth suicide rates are radically lower." (10)

Cultural resurgence as a co relational aspect for healing of suicidal youth may have a direct impact on therapy with Aboriginal youth. Therapeutic interventions and community healing that dovetails with ownership by the First Nations Band in the following areas called "markers of cultural continuity" (11) include: 1) land claims 2) self-government 3) education services 4) police and fire services 5) health services 6) cultural facilities

Intercultural workers need to be acutely aware of the changes within the First Nations community to which they are attached. This means understanding the socio-historical loss, complicated grief and mourning, and current life stresses, within the application of art therapy for First Nations youth and families. The growth of increased community autonomy and ownership within the aforementioned areas may have a direct impact on therapeutic success. The therapist cannot work in isolation, but must join the community within cultural and resource ownership and reclamation. The web of hope and healing includes the community, family and individual. Thus, the social and psychological changes for Aboriginal suicidal youth are in tandem with First Nations community healing.

References:

1) Leenaars, A., Brown, C., Taparti, L., Anowak, J. & Hill-Keddie, T. (1999). Genocide and suicide among indigenous people: the north meets the south. The Canadian Journal of Native Studies, 19(2), p.351. 2) Kirmayer, L., Brass, G. & Tait, C. (2000). The mental health of aboriginal peoples: Transformations of identity and community. Canadian Journal of Psychiatry, 45(7). 607-616.

3) Leenaars; Brown; Taparti; Anowak; Hill-Keddie, (1999), p.346; 4) Leenaars/ Brown/ Taparti / Anowak/ Hill-Keddie, (1995), p.350 5) SPI; Mheccu fact sheet; (2002). www.mheccu.ubc.ca.sp 6) MSB, Health Canada, Brighter Futures Initiative, Discussion notes from the suicide prevention workshop, February 1995. 7) SPI: Mheccu, UBC. www.mheccu.ubc.ca.sp/publications/readings.cfu 8) Leenaars/ Brown/ Taparti / Anowak/ Hill-Keddie, (1995), p.349. 9) Chandler, M. & Lalonde, C. (1998). Cultural continuity as a hedge against suicide in Canadas first nations. Transcultural Psychiatry, 35(2), p.191. 10) Chandler, M. & Lalonde, C. (1998). Cultural continuity as a hedge against suicide in Canadas first nations. Transcultural Psychiatry, 35(2), p.192. 11) Chandler, M. & Lalonde, C. (1998). Cultural continuity as a hedge against suicide in Canadas first nations. Transcultural Psychiatry, 35(2), p.209,

Web References:

Suicide Prevention and Information http://www.mheccu.ubc.ca http://library.adelaide.edu.au/guide/med/menthealth/suicide.html http://www.mheccu.ubc.ca/SP/index.cfm http://www.suicideassessment.com/ http://www.wiley.com/remtitle.cgi?isbn=0471237612 http://www.nimh.nih.gov/research/highrisksuicide.cfm

Depression http://www.psycom.net/depression.central.html Mental Health Evaluation and Community Consultation Unit, Department of Psychiatry, University of British Columbia, Canada. http://www.mheccu.ubc.ca