The People Who Give More: Health and Mental Health Among the Contemporary Puyallup Indian Tribal Community George M. Guilmet and David L. Whited ) www.ucdenver.edu/caianh ( Health American Indian and Alaska Native Mental Health Research The Journal of the National Center Monograph Series Centers for American Indian and Alaska Native AmericanIndian andAlaska NativeMental Health Research Copyright: Volume 2, Monograph 2, Winter 1989 ColoradoSchoolofPublic Health/University ofColorado AnschutzMedical Campus Published by the National Center University of Colorado Health Sciences Center Department of Psychiatry 4200 East Ninth Avenue, Campus Box C249 Denver, Colorado 80262 ISSN 0893-5394 EDITOR-IN-CHIEF Spero M. Manson, Ph.D. JOURNAL MANAGER Judy K. Kuntze-Colby RESEARCH ASSOCIATES CAROLYN L. ATINEAVE, Ph.D. GEORGE M. GUILMET, Ph.D. Professor Emeritus Dept. of Comparative Sociology University of Washington University of Puget Sound ANNA E. BARON, Ph.D. ROBERT HACKENBERG, Ph.D. Department of Psychiatry Department of Anthropology University of Colorado H.S.C. University of Colorado, Boulder JANETIE BEALS, Ph.D. SANDRA K. JOOS, Ph.D. ) Department of Psychiatry Health Services Research Un iversity of Colorado H.S.C. Portland VA Medical Center www.ucdenver.edu/caianh ( Health DONALD W. BECHTOLD, M.D. J. DAVID KINZIE, M.D. Department of Psychiatry Department of Psychiatry University of Colorado H.S.C. Oregon Health Sciences University Centers for American Indian and Alaska Native MORTON BEISER, M.D. TERESA LaFROMBOISE, Ph.D. AmericanIndian andAlaska NativeMental Health Research Department of Psychiatry School of Education Copyright: University of British Columbia Stanford University ColoradoSchoolofPublic Health/University ofColorado AnschutzMedical Campus JOSEPH D. BLOOM, M.D. PAULK. LEUNG, M.D. Department of Psychiatry Department of Psychiatry Oregon Health Sciences University Oregon Health Sciences University JAMES BOEHNLEIN, M.D. JERROLD E. LEVY, Ph.D. Departm ent of Psychiatry Department of Anthropology Oregon Health Sciences University University of Arizona LtN BRUCE, Ph.D. CAROL LUJAN, Ph.D. Departm ent of Psychology School of Justice Studies Washington State University Arizona State University NORMAN G. DINGES, Ph.D. PHILIP A. MAY, Ph.D. Department of Psychiatry Department of Sociology Oregon Health Sciences University University New Mexico CANDACE M. FLEMING, Ph.D. BEATRICE MEDICINE, Ph.D. Department of Psychiatry Department of Anthropology University of Colorado H.S.C. California State Univ., Northridge RESEARCH ASSOCIATES (Continued) GERALD V. MOHATT, Ed.D. RICHARD SCHULZ, Ph.D. Human/Rural Development College Cathedral of Learning University of Alaska, Fairbanks University of Pittsburgh GORDON NELIGH, M.D. JAMES H. SHORE, M.D. Department of Psychiatry Department of Psychiatry University of Colorado H.S.C. University of Colorado H.S.C. KEN PEPION PAT SILK-WALKER, R.N., M.S. Native American Studies Program Psychosocial Nursing Department University of Montana University of Washington RON PETERS, B.A. JOSEPH E. TRIMBLE, Ph.D. Greater Vancouver Community Department of Psychology Mental Health Services Western Washington University C. JOSEPH PINE, Ph.D. R. DALE WALKER, M.D. ) Psychology Services Alcohol & Drug Treatment Unit www.ucdenver.edu/caianh Sepulveda VA Medical Center Seattle VA Medical Center ( Health JOHN RED HORSE, Ph.D. JOSEPH WESTERMEYER, M.D. American Indian Studies Center Department of Psychiatry University of California, Los Angeles University of Minnesota Centers for American Indian and Alaska Native AmericanIndian andAlaska NativeMental Health Research WILLIAM H. SACK, M.D. DIANE J. WILLIS, Ph.D. Copyright: Department of Psychiatry Child Study Center Oregon Health Sciences University Oklahoma Health Sciences Center ColoradoSchoolofPublic Health/University ofColorado AnschutzMedical Campus GRACE POWLESS SAGE, Ph.D. ARONS. WOLF, M.D. Multicultural Center for Counseling Langdon Clinic University of Colorado, Boulder Anchorage, Alaska BOBBY WRIGHT, Ph.D. Indian Studies Program Montana State University Subscription rates are $35 (US currency) per volume--including 3 issues plus an annual monograph. Make checks payable to: UCHSC/National Center/Journal. Mail to National Center for American Indian and Alaska Native Mental Health Research, Campus Box C249, 4200 East Ninth Avenue, Denver, Colorado 80262, Attn: Journal Manager. ISSN 0893-5394 @1989 The Center for American Indian and Alaska Native Mental Health Research Denver,Colorado All Rights Reserved ) www.ucdenver.edu/caianh ( Health Centers for American Indian and Alaska Native AmericanIndian andAlaska NativeMental Health Research Copyright: ColoradoSchoolofPublic Health/University ofColorado AnschutzMedical Campus The People Who Give More: Health and Mental Health Among the Contemporary Puyallup Indian Tribal Community George M. Guilmet and David L. Whited American Indian and Alaska Native Mental Health Research Volume 2, Monograph 2, Winter 1989 ) www.ucdenver.edu/caianh ( Health Introduction 9 Centers for American Indian and Alaska Native Acknowledgments 13 AmericanIndian andAlaska NativeMental Health Research Copyright: Authors' Statement 17 ColoradoSchoolofPublic Health/University ofColorado AnschutzMedical Campus Chapter One The Historical Context Ethnohistory of the Puyallup Mental Health Care System 19 Broader Medical Context 25 Impact of Western Medicine 27 Chapter Two The Contemporary Situation The Puyallup Tribal Community 33 The Mental Health Care System 36 Chapter Three Health Care and Health Care Seeking Strategies Introduction 41 Research Methods 41 Results 43 Discussion 49 Conclusions 54 Chapter Four Mental Health in a General Health Care System The Problem 57 Mental Health Care within a Primary Health Care Clinical Facility 57 Coordination of Primary Care with Basic Mental Health Services 61 ) Conclusions 65 www.ucdenver.edu/caianh ( Health Chapter Five Cultural Lessons for Clinical Mental Health Practice Centers for American Indian and Alaska Native Introduction 68 AmericanIndian andAlaska NativeMental Health Research Cultural Maps 69 Copyright: Family Structure 70 Ritual and Ceremonialism 73 ColoradoSchoolofPublic Health/University ofColorado AnschutzMedical Campus Values and Value Conflict 76 Educational Conflict 79 Sense of Time and Self 81 Communication Styles 84 Prejudice or Pride 88 Barriers to Services in the Non-Indian Community 90 Cultural Sensitivity 91 Chapter Six Contemporary Health Care Crisis The Current Health Care Situation 95 Legal and Historical Basis for Indian Health Services 97 The Puyallup Tribal Position Summarized 98 Chapter Six (continued) Contemporary Health Care Crisis The Medicine Creek Treaty and Medical Care: A Federal Responsibility 99 Puyallup Response to Proposed Eligibility Criteria 101 Puyallup Response to Contract Care Payment Limitation on Reimbursements to Medicare Rates 105 The Perspective of Anthropology 106 Should Any Tribe Support the Quarter Blood IHS Criteria? 108 The Duties of the Trustee no Chapter Seven Incontinence and Biomedicine ) Introduction www.ucdenver.edu/caianh 113 ( Health Definitions 113 Historic Examples 116 Conclusions 125 Centers for American Indian and Alaska Native AmericanIndian andAlaska NativeMental Health Research Authors' Notes 127 Copyright: ColoradoSchoolofPublic Health/University ofColorado AnschutzMedical Campus References 131 About the Authors 141 .