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April 22, 2010

Learning from Native North America for Health Care

By Lewis Mehl-Madrona

The traditional healing of North America is slowly findings its way into conventional clinical settings. Not everyone (Native and non-Native) agree with its entry there. Some people believe that traditional healing should be restricted to Native people and kept away from Non-Natives. Others believe it should be openly shared with all. Even knowing what is a traditional healer is a debated question. Some people call themse


This weekend, I taught a sociology course on Native American ceremony in which we wondered how traditional healing could be incorporated more into mainstream health care, both as practice, but also as principle. We looked at the range of what is occuring across North American. Perhaps the most integrated and innovative program is at the Aboriginal Health Unit of the University of Manitoba. There, in downtown Winnipeg, a client can ask the receptionist to see either the traditional healer or the conventional physician. Both the healer and the physician are on salary and the services of both are a covered benefit for clients. As far as I know, anyone can see the traditional healer. One does not have to be a Native American person to use the services of the healers, and, as far as I know, these healers are willing to work with anyone who comes to see them. The healers have a beautiful thunderbird shaped building in which to do ceremony. Offices ring the outer circle with doors of entry at each of the four directions. A central open space includes a large grate in the middle that can be removed to build fire. Nearby, the City turned a parking lot into an environment for the healers to do sweat lodge and other outdoor ceremonies. Knowing Judy Bartlett,the medical director of this facility, I imagine that the healers and the physicians have some interesting discussions and engage in what has been called explanatory pluralism -- the idea that multiple,ovelapping levels of explanation can exist for any phenomenon, and our inability to see how the levels connect, or to explain one level in terms of another, doesn't invalidate any level. My favorite example of this comes from the life of James Walker, physician to the Pine Ridge Lakota Reservation from the 1880s through the early 1900s and first non-Native person to be taught to be a wicasa wakan, or healer. Early in his career, Walker attempted to convince his later teachers that tuberculosis was caused by a bacillus and not by an evil spirit. To convince them once and for all, he set up a slide in a microscope and urged the healers to look at it. "This is what causes tuberculosis," he proudly announced. The healers looked and got vey excited. "This is what we saw in our vision," they said. "This was our vision of the evil spirit." From then on, Walker was much more accepting of Lakota explanaations.

In our internet searching for other programs, however, my students discovered that not all people of Native North American ancestry agree with programs like Winnipeg's. Some believe that healers should never receive any compensation and should remain completely aloof and apart from the conventional medical system. Others object to healers helping non-Native people. Others believe that only those of "pure blood" should be healers. We found a tremendous argument about what is traditional healing and who should do it.

My students noted with irony a previous discussion we had in which they learned that the "blood quantum" system was only created in 1904 by an act of the U.S. Congress, the goal of which was to eliminate eventually all "Indians." The members of Congress and their advisors had been influenced by an offshoot of Charles Darwin and Gregor Mendell, the field of eugenics. In those days, race was supposed to explain everything criminality, laziness, intelligence, and more. Racial purity was sought as important. Members of Congress opined that Native American people would begin to marry non-Natives and they would marry members of other tribes. If a percentage of "Indian blood" was established below which services would end, perhaps they could eliminate the Bureau of Indian Affairs and close that faucet which they saw as draining money that should be going elsewhere. Theresa O'Nell, in her book, Disciplined Hearts, tells the story of the Flathead Tribe of Montana enrolling under the auspices of the Indian Agent in the late years of the 19th century. Anyone who identified as Blackfoot was enroled, regardless of "blood quanta" since that concept had not yet come into being. Elsewhere and earlier (in the 1820s), the head chief of the Cherokee Nation, John Ross, was 100% Cherokee, representing the Nation to Andrew Jackson in its delegation to prevent the relocation of the Cherokee from Tennessee to Oklahoma. Technically, John Ross was 7/8s Scottish, but that was barely noticed. Darwin was just writing On the Origin of Species. Mendell's work was not known in the Americas. The notion of genetics and percentage of race had not yet been invented, and, actually Darwin scoffed at the concept when he heard about it. He responded that no gene existed for race, that race was a social construct. Genes exists for skin darkness, for controlling height, for facial features, but these genes often varied as much within a group as between the groups. Darwin strongly objected to the categorization of people from Africa as inferior and to their subjugation as slaves on the basis of skin color.

We asked the question, is "Indianness" a social construction or a genetic fact. We found many definitions of "Indianness" including genetic, participation in ceremonies, living a traditional lifestyle, self-declaration, speaking the language, living on a reserve, and more. Many of the definitions overlapped and interacted to create a competition for "indianness", which was so well-described by O'Nell. Eduardo Duran, a Pueblo psychologist, and co-author of Native American Post-Colonial Psychology, describes what he calls the MITT syndrome, or "More Indian than Thou." In my own life, I have felt this scrutinizing gaze. As I described in Coyote Medicine, I was raised by Cherokee grandparents in an interesting (to me now) blend of traditional Cherokee cosmology and spirituality and their unique blend of Christianity. That was inevitable in the Kentucky of those days. It was hard to escape Christianity. I know of heritage from Lakota and French-Canadian on my father's side, and Scottish and Cherokee on my mother's side. Probably other influences exist. I felt Less Indian than Thou most of the time, at powwows, ceremonies, and other gatherings. Nevertheless, I have studied and practiced my own version of Native American spirituality for many years.

Another hero of mine is Charles Eastman, or Ohiyesa. He lived a traditional Oglala life until a teenager when his father resurfaced after having been given up for dead. Charles' father had been in a government prison for fighting the U.S. Cavalry and was finally released. He came home to encourage Charles to learn the ways of the mainstream world to help with his people's survive. Charles did just that, attending Dartmouth College and then Boston University School of Medicine. After internship, Charles returned to be the physician for Wounded Knee, South Dakota, for many years. He wrote 17 books, most of which are still in print, and helped found the Boy Scouts of America. In one of his books, Charles wrote that Oglala spirituality is a highly personal matter. There is no governing body to decide what is true or false, no priests, no ecclesiastical boards, no church hierarchy. There are teachers and holy men, but if one disagrees, he can just walk away and find another. Nature and Creator are the prime authority. That has been my perspective on my own spirituality.

The students and I discussed these various points of view. Being college-age, they pointed out that anything unappealing to young people will die out. They did not think the view of noble poverty and never being paid could last long. "Kids want stuff," they said. "They want what they see on MTV." That had certainly been my experience working on reservations. MTV and its culture is stronger often than traditional spirituality or Chistianity for youth. I suspected they were correct in believing that an insistence on poverty as a requirement for being a healer would turn many youth away. My own view is that healers should be a part of our health care system and they should be paid in the same way that physicians are. Personally, I would prefer being on salary with a panel of people for whom to care. As I have written previously, I believe that the piecemeal system of charging for each patient is wasteful and inefficient and encourages physicians to spend as little time with patients as possible.

Of less prominence on the internet is the discussion that I have been having at conferences and meetings about revising contemporary medicine based upon the insights of traditional healing. That means exploring the concept of relational mind, or mind that exists between people in relationships inside of inside people. It also means involving the community in treatment and embracing the concept that the sick person is doing a service for the community by showing that dysharmony and imbalance exist. In order to help the individual, his or her entire community needs to embrace the search for imbalance and the restoration of order and harmony. I also think the wisdom of traditional healing shows us the power of energy medicine. So much of what healers do falls under the contemporary category of energy medicine and is being seriously researched now in academic centers. Prayer and its power is also receiving serious attention as well as the power of belief.

We did find an interesting trend on the internet discussion groups we visited, to view any CAM (complementary and alternative medicine) as "New Age." We found a dichotomy between traditional North American healing and "everything else" on some websites. My students believed that our health care system needs to make room for traditional medicines of all kinds Oriental, Ayurvedic, African, and North American. They felt that North American traditional healing should be showcased more than it is in North America. We noticed that Chinese Medicine gets much more internet time than North American healing.

We found critics of everything. I certainly fall into doing things to which some would object. I use drama therapy techniques to help people understand things as diverse as the inner workings of the minds of a person diagnosed with schizophrenia to understanding the interactions of the beings of the Lakota cosmology. Fundamentalists could object to this. I have also led a class to re-enact the winter buffalo hunt ceremony, which has not been done for over 100 years. I think this ceremony deserves to make a comeback and we did have an amazing experience reading ethnological accounts of the ceremony, praying for guidance on how to re-enact it, and then performing the ceremony. I plan to do this again next winter and hope more people will join me. Of interest was our discussion before doing the ceremony of what "buffalo" as a symbol means in our modern lives. As a marker of abundance, buffalo can mean education, social capital, income, and more.

I have also let my study of traditional North American healing inform my healing work with people. Currently I live a sort of dichotomy between my medical work and my healing work. When someone comes for healing, I ask them to contribute to me whatever makes their heart glow with generosity but not enough to bring them any resentment. That approach has its ups and downs and I have been paid in rocks, cigarettes, crystals, and other things that don't may my rent. Since I became a sundancer and picked up the sacred pipe to carry, this has seemed the right way to proceed. I use ceremony, energy medicine, bodywork, and more in my work though I don't call myself a traditional healer. I was not trained as a traditional healer. I did not grow up on a reservation, though some people have humerously referred to my homeland of Eastern Kentucky as a reservation created by coal mining. Our town still has 60% of its households earning less than $10,000 per year. I actually don't know what to call myself, so I humorously call what I do coyote healing because it's an amalgamation of everything I've ever learned. My medical work is influenced by this also, but in more circumspect ways. One must behave more conventionally in medic al settings and the relationships formed there are more tightly scripted. If I start seeing someone as a psychiatrist, I would not move them into my healing work, because too many people could object to saying that now I was engaged in boundary violations. If we start medical, we stay medical, but, hopefully,in a more enlightened and informed way.

I do think we need to bring all the world's traditional healing into our medical practice, but this will be slow going. It will not happen overnight or be acceptable. Until that happens, perhaps some of us doing healing on the side and not as physicians will be a bridge between the traditional healing that happens on reservations and in small bedrooms in urban areas and the activities of the modern medical clinic. Time will tell what directions all this things will take.

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Authors Bio:
Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and Narrative Medicine.