EXPLORING A SHARED HISTORY OF COLONIZATION, HISTORICAL TRAUMA i EXPLORING A SHARED HISTORY OF COLONIZATION, HISTORICAL TRAUMA AND LINKS TO ALCOHOL USE WITH NATIVE HAWAIIANS LIVING IN RURAL HAWAII IN THE 21ST CENTURY A DISSERTATION SUBMITTED TO THE GRADUATE DIVISION OF THE UNIVERSITY OF HAWAII IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN NURSING MARCH 20th, 2020 By Cynthia Taylor Greywolf, DNP-PMHNP, BC Cherokee Nation Tribal Member Dissertation Committee: John Casken, Chairperson Alan Katz Merle Kataoka-Yahiro John Lowe Abbie Neves Keywords: Keywords: Colonization, historical trauma, intergenerational trauma, unresolved grief, American Indians, Native Americans, Alaska Natives, Native Hawaiians. “Funding for this dissertation was made possible (in part) by Grant Number1H79SM080386-01. The views expressed in written training materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. government.” EXPLORING A SHARED HISTORY OF COLONIZATION, HISTORICAL TRAUMA ii Dedication This dissertation is dedicated to the Native Hawaiian co-researchers who so kindly agreed to participate in this exploratory study and share their stories and experiences of colonization and historical trauma. Your resilience, strength, determination and perseverance are inspirational. Thank you for contributing your stories and adding to the growing tapestry of American Indigenous people’s experiences of forced colonization. I would also like to dedicate this work to my Cherokee maternal grandfather and to my great, great grandmother Lizzie Groundhog who survived the Trail of Tears and to my ancestors who did not survive. EXPLORING A SHARED HISTORY OF COLONIZATION, HISTORICAL TRAUMA iii Acknowledgements I would like to acknowledge Dr. Merle Kataoka-Yahiro for sponsoring, encouraging and supporting me in applying for the American Nurses Associations’ (ANAs’) Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship program ((MFP). I would also like to thank Dr. John Casken for guiding and supporting me throughout this six-year journey which at times was very challenging. I can never thank you both enough for your encouragement and support through some of my most difficult times. I am grateful to you. To my MFP family, Ms. Janet Jackson, Dr. Frieda Outlaw, Dr. John Lowe, Dr. Beverly Patchell and all of my MFP family. Thank you for your unwavering support and words of encouragement throughout this journey. I am so proud to be a part of your family. Also, to Nalani Minton, my colleague and friend. Thank you for your friendship, support and encouragement over these many years and for all of your insights about the impact of colonization and historical trauma on Indigenous peoples. Thank you for walking with me along this difficult path. You are cherished. I would like to take the time to acknowledge Dr. Nina L. Etkin (June 13, 1948 – January 26, 2009), professor of medical anthropology, ethnobiology and ethnopharmacology at the University of Hawaii, Manoa. In my early days when I wasn’t sure academia was the place for me, Dr. Etkin supported, guided and believed in my ability to achieve my dreams. I want to acknowledge Dr. Eric Kjellgren and Dr. Lisa Humphrey now both cultural anthropologists well into successful careers. Thank you for bringing love, light, humor and laughter into my life during those early academic years. You were not only my best friends, but you inspired me throughout the years with your great successes. You are always in my heart. EXPLORING A SHARED HISTORY OF COLONIZATION, HISTORICAL TRAUMA iv Abstract American Indigenous populations, American Indians (AIs), and Alaska Natives (ANs) have experienced historically traumatic events over the past 500 years, and Native Hawaiians (NHs) over the last 240 years from contact with Europeans, and the subsequent colonization, and appropriation of traditional homelands. Colonization resulted in massive losses of people, and culture including loss of cultural knowledge, traditions, land, and identity. The proximal issues of racism, discrimination, oppression, and marginalization have compounded the problem leaving a long legacy of unresolved historical trauma and a complex form of chronic Post- Traumatic Stress Disorder (PTSD), and unresolved grief among individuals in the tribes and groups. Indigenous scholars have posited historical trauma as a prime cause of the current social pathology among AI/AN/NH populations through the inter-generational transmission of stress leading to high rates of suicides, homicides, domestic violence, child abuse, alcohol, and substance use, and mental health disparities. AI researchers have emphasized the need to study historical trauma in relation to specific sociocultural contexts. Research exploring the impact of colonization and historical trauma has been conducted with AIs and ANs demonstrating a link between historical trauma, and increased physical and mental health disparities, alcohol, and other substance use. Little is known about the behavioral risks of substance use that may have resulted from colonization and historical trauma in NHs. There are specific cultural and historical losses which are unique to NHs who are at a higher risk for poorer mental health outcomes, and alcohol and other substance use compared to other ethnic populations in Hawaii. NHs have a history, similar to AIs/ANs, which elevates the importance of exploring their lived experience, and perceptions of colonization, historical trauma and links to alcohol use in the 21st century. EXPLORING A SHARED HISTORY OF COLONIZATION, HISTORICAL TRAUMA v Table of Contents Dedication ....................................................................................................................................... ii Acknowledgements ....................................................................................................................... iii Abstract ........................................................................................................................................... iv List of Tables .................................................................................................................................. ix List of Figures.................................................................................................................................ix List of Abbreviations.......................................................................................................................x Chapter 1:Introduction ..................................................................................................................... 1 Background of the Concept of Historical Trauma in AIs ................................................................ 3 The AI/AN Historical Context ........................................................................................................ 5 NH Historical Context ..................................................................................................................... 7 The Introduction of Alcohol in Hawaii ........................................................................................... 9 Phenomenon of Interest ............................................................................................................. 11 The Role and Impact of Alcohol from a Western Perspective ...................................................... 11 The Role and Impact of Alcohol from an AI/AN Perspective ...................................................... 11 Historical Trauma Conceptual Framework ................................................................................... 11 Historical trauma.. ..................................................................................................................... 11 Historical trauma response (HTR).............................................................................................12 Historical unresolved grief.. ...................................................................................................... 12 The Historical Trauma Socio-Psychological Explanatory Framework ..................................... 15 Story Theory .................................................................................................................................. 16 Connecting with Self-in-Relation .............................................................................................. 19 Creating Ease ............................................................................................................................. 19 Relationships among the concepts: The model ......................................................................... 20 Problem Statement ......................................................................................................................... 20 Purpose of the study ...................................................................................................................... 21 Research Question ......................................................................................................................... 21 Significance ................................................................................................................................... 21 Definitions of Terms .....................................................................................................................