Culture & Mental Health Research Unit Report No. 10 The Mental Health of Indigenous Peoples Proceedings of the Advanced Study Institute The Mental Health of Indigenous Peoples McGill Summer Program in Social & Cultural Psychiatry and the Aboriginal Mental Health Research Team May 29 – May 31, 2000 Montréal, Québec Editors Laurence J. Kirmayer Mary Ellen Macdonald Gregory M. Brass Institute of Community and Family Psychiatry Sir Mortimer B. Davis — Jewish General Hospital & Division of Social and Transcultural Psychiatry Department of Psychiatry, McGill University © 2001 Division of Social & Transcultural Psychiatry McGill University Contents Preface & Acknowledgement 3 1. Introduction The Mental Health of Aboriginal Peoples 5 — Laurence J. Kirmayer, Gregory M. Brass & Caroline L. Tait 2. Social Origins of Distress “The Deep Sleep of Forgetfulness”: Reflecting on Disremembering 26 — Ernest Hunter Health Implications of Political Violence, Ethnic Conflict and Contemporary Wars In Latin America 47 — Duncan Pedersen The Legacy of the ‘Stolen Generations’ in Australia 69 — Jane H. Mckendrick 3. Individual And Collective Responses To Suffering An Overview of Suicide in Indigenous Australia 81 — Ernest Hunter Aboriginal Identity and the Construction of Fetal Alcohol Syndrome 95 — Caroline L. Tait 4. Transformations of Identity & Community Healing the Aboriginal Offender: Identity Construction Through Therapeutic Practice 112 — Gregory M. Brass Towards A Recuperation of Souls and Bodies: Community Healing and the Complex Interplay Of Faith And History 120 — Naomi Adelson Negotiating Health: Meanings of Building a Healthy Community in Igloolik 135 — Kristiann Allen The Problem of “Culture” and the Counseling of Aboriginal Peoples 145 — James B. Waldram 5. Models For Collaborative Research & Mental Health Services Working in Partnership: Innovative Collaborative Research Between Aboriginal Communities and an Academic Unit 160 — Jane H. Mckendrick Comments on Hollow Water Community Healing — Joseph Couture 173 An Overview of Six Nations Mental Health Services 177 — Cornelia Wieman Contributors & Discussants 186 Contact Information 190 Conference Schedule 192 Annual McGill Summer Program in Social & Cultural Psychiatry 193 Aboriginal Mental Health Research Team 194 3 Preface & Acknowledgement This report presents the proceedings of a conference on “The Mental Health of Indigenous Peoples” organized by the Aboriginal Mental Health Team of the Culture & Mental Health Unit, Sir Mortimer B. Davis—Jewish General Hospital in Montreal May 29-31, 2000. The conference was organized in conjunction with the Annual Summer Program in Social and Cultural Psychiatry of the Division of Social & Transcultural Psychiatry, McGill University. The aim of the meeting was to bring together experts on mental health research among indigenous peoples in Canada, the US and Australia to exchange perspectives, methods and models for research and service delivery. The meeting was supported by grants from the Conseil québecois de la recherche sociale. Many people assisted with the organization of the conference and the subsequent preparation of these proceedings. We thank all of our colleagues and the staff of the CMHRU for their help and support. It is our hope that this report will help those working in and with Aboriginal communities in Canada and elsewhere to conduct meaningful research and promote culturally responsive mental health services. Laurence J. Kirmayer Montreal, January 2001 4 5 1. INTRODUCTION The Mental Health of Aboriginal Peoples: Transformations of Identity and Community1 Laurence J. Kirmayer, Gregory M. Brass, and Caroline L. Tait Abstract: This paper reviews some recent research on the mental health of the First Nations, Inuit and Métis of Canada. We summarize evidence for the social origins of mental health problems and illustrate the ongoing responses of individuals and communities to the legacy of colonization. Cultural discontinuity and oppression have been linked to high rates of depression, alcoholism, suicide, and violence in many communities, with the most dramatic impact on youth. Despite these challenges, many communities have done well and research is needed to identify the factors that promote wellness. Cultural psychiatry can contribute to rethinking mental health services and health promotion for Indigenous populations and communities. Résumé: Cet article examine un certain nombre de recherches récentes portant sur la santé mentale des Premières Nations, des Inuits et des Métis du Canada. Nous récapitulons les preuves militant en faveur des origines sociales des problèmes de santé mentale et illustrons les réponses actuelles d’individus et de communautés face à l’héritage de la colonisation. La discontinuité culturelle et l’oppression ont été associées à des taux élevés de dépression, d’alcoolisme, de suicide, et de violence dans de nombreuses communautés, avec l’impact le plus dramatique exercé sur la jeunesse. En dépit de ces défis, nombre de communautés s’en sont très bien tirées et de la recherche s’avère nécessaire afin de pouvoir identifier les facteurs qui favorisent le bien-être. La psychiatrie culturelle peut contribuer à repenser les services de soins en santé mentale et la promotion de la santé pour les populations et communautés autochtones. Introduction Around the world, Indigenous peoples have experienced rapid culture change, marginalization, and absorption into a global economy with little regard for their autonomy. Cultural discontinuity has been linked to high rates of depression, alcoholism, suicide, and violence in many communities, with the most dramatic impact on youth. Despite these challenges, many communities have done well. This paper will explore issues in the mental health of the First Nations, Inuit and Métis peoples of Canada. We first summarize the social origins of distress among the original inhabitants of North America. We then discuss the range and magnitude of the individual 1 A version of this paper appeared in the Canadian Journal of Psychiatry 2000. 6 and collective problems caused by this history of systematic suppression and dislocation. We also consider some of the ongoing transformations of individual and collective identity and forms of community that hold the seeds of revitalization and renewal for Aboriginal peoples. Finally, we outline some implications of an emphasis on identity and community for mental health services and health promotion. First Nations, Inuit and Métis constitute about 1 million people or 4% of the Canadian population. There are 11 major language groups, more than 58 dialects and some 596 bands residing on 2284 reserves, cities and rural communities (Frideres, 1998; Morrison & Wilson, 1988). The cultural and linguistic differences among many groups are greater than the differences that divide European nations. In addition to the social, cultural and environmental differences between groups, there is an enormous diversity of values, lifestyles and perspectives within any community or urban Aboriginal population. This diversity makes lumping people together under generic terms like Aboriginal or Indigenous profoundly misleading; nevertheless, most groups share a common social, economic and political predicament that is the legacy of colonization. This shared predicament has motivated efforts to forge a common political front and, to some degree, a collective identity among diverse groups. Indeed, there are striking parallels in the mental health problems of Indigenous peoples around the world suggesting that, while biological, social, cultural and political factors vary, there are common processes at work (Hunter, 1993; Kunitz, 1994; Spencer, 2000). Social Origins of Distress Despite myths of a timeless past and cultural continuity, traditional Aboriginal societies were not static, nor were they entirely free of disease or social problems (Ray, 1996; Waldram, Herring & Young 1995). However, a dramatically accelerated process of cultural change began in the 16th century, the result of European fishing expeditions, European exploration, and the European missionaries, fur traders and colonists who moved to the New World. As well, Mesoamerican and Caribbean Natives accompanied some European expeditions, which brought different Indigenous cultures into contact as well (Trigger & Swagerty, 1996). The history of the European colonization of North America is a harrowing tale of decimation of the Indigenous population by infectious disease, warfare, and an active suppression of culture and identity (Stannard, 1992; Thornton, 1987). Estimates of the indigenous population of North America prior to the arrival of Europeans range upward from about 7 million. Close to 90% of these people died as a result of the direct and indirect effects of culture contact. For example, Northern Iroquoian peoples may have shrunk from about 110,000 in the 16th and early 17th century to about 8,000 by 1850 (Trigger & Swagerty, 1996). Economic, political, and religious institutions of the European settlers all contributed to the displacement and oppression of indigenous people. 7 Culture contact brought with it many forms of depredation including infectious diseases, among which the great killers were smallpox, measles, influenza, bubonic plague, diphtheria, typhus, cholera, scarlet fever, trachoma, whooping cough, chicken pox, and tropical malaria. A growing reliance on European foodstuffs also had profound effects on the health of Indigenous peoples. These effects continue to the present day