Arizona Psychiatric Society Newsletter, Vol. 5, No. 1, 2014

I appreciate the invitation to address my Arizona colleagues on the psychiatric care of Native Americans. Generally, when we hear the words psychiatric care and Native Americans, it immediately conjures up a symptomatic population rife with substance abuse, domestic violence, high suicide rates among the young, and educational underachievement; because the literature focuses on these aberrations. The underlying psychological explanations for these problems are attributed to internalized anger, and the powerlessness resulting from their subjugation and political disenfranchisement. These ongoing symptomatic manifestations are attributed to the transgenerational transmission of their historical trauma.

There is not much in the literature about the transgenerational transmission of resilience among Native Americans; how did some tribes survive the assaults on their culture while others fade away? I have spent much of my professional life working with Native Americans, and would like to tell you their story from that perspective. The tribes who thrived were the ones who maintained a connection to the values and cultural systems (language, myths, rituals and ceremonies) handed down from generation to generation. Resilience is rooted in the nurturing soil of knowing who you are in the world. If you have a sense of yourself as unique in a positive way when you are young you greet the world as equal when you become an adult.

First, a brief history of how I came to work in Indian Country. It was the mid-60’s, and I didn’t want to go to Viet Nam; so after completing my internship I served my military obligation in the Indian Health Service. I thought it would be a 2-year experience but it turned into more than 20. Shortly after my arrival at the Santa Fe Indian Hospital in 1965 I was introduced to an old man on morning rounds who would be my patient because I provided the aftercare in his village. He was admitted in acute congestive heart failure, and was resting comfortably since he’d been digitalized, given a diuretic and oxygen.  I introduced myself, and then he asked me “where did you learn how to heal?” I assumed he was asking for my academic credentials so I tell him where I went to medical school and completed my internship, and when I finished he looked at me smilingly and asked “do you know how to dance?”

I was touched by his whimsy, thought I’d humor him, and said I knew how to dance and shuffled my feet at his bedside. The old man laughed, so I asked him if he knew how to dance, not knowing at the time he was a renowned medicine man. So he got out of bed the oxygen running and did the steps to a Corn Dance at the bedside, When he got back into bed he said to me “you must be able to dance if you are going to heal people” so I asked him if he would teach me those steps and he said “I can teach you my steps, but you have to hear your own music”.

I learned from Native healers that there were many ways to do the healing dance and what it meant to be healthy. Health was never defined in medical school, other than if you weren’t sick then you were healthy). And I learned about how many ways there were for people to get sick and how many ways to do the healing dance.

Most of us in Western medicine (especially in psychiatry), learn to do our healing dance one way; we become proficient in whatever our preferred methodology (psychopharmacology, neurobiology, psychotherapy, behavioral therapy, cognitive therapies, psychoanalysis), and then spend most of our professional lives refining the steps to that familiar tune.

The Navajo word for health is HOZHO… the same word also means harmony, truth, beauty, balance and the Great Spirit. Being healthy is when what you say with your lips, is the same story you’re telling by your actions, and what you truly believe in your heart; that’s when you are in balance, in truth. In the language of modern medicine this is the science of psychoneuroimmunology.

From Native healers I learned the importance of rituals, ceremonies, and sacred objects in setting the stage in opening ones heart, which is critical in healing; and that people heal better in community because the more people you have helping you/pulling for you, the more likely you’ll have a positive outcome. I was also awakened to many ways of altering human consciousness, and helping people see the familiar with new eyes that included the use of powerful psychoactivating substances has been used to heal the mind/body/spirit for thousands of years. The current explorations in the use of psilocybin mushrooms, and the Schedule III drug Ketamine for use in depression and end-of-life anxiety have been part of the indigenous therapeutic armamentarium for millennia.

I learned that no matter how much we know about the brain (its neurobiology and chemistry), that it will always have a mind of its own and some phenomena can’t be satisfactorily explained.

Those Native people who maintained a credible connection to their psychohistory, to the wisdom stories and ceremonial practices of their tribes, survived the vagaries of assimilation psychically intact, because that’s how we learn who we are in the world. It turns out that our survival as a species is not transmitted through our DNA, but through our stories. The road to resilience is in rediscovering old wisdom…stay connected in community, trust the truth of your heart, and keep your mind open to new ways of seeing, hearing, and doing the healing dance.

Hammerschlag, Carl A. The Dancing Healers, Harper/Collins, San Francisco, 1988
Hammerschlag, Carl A. The Theft of the Spirit, Simon and Schuster, New York, 1993
Hammerschlag, Carl A. and Howard Silverman. Healing Ceremonies, Putnam/Perigee, New York, 1998
Hammerschlag, Carl A. Kindling Spirit: Healing From Within, Turtle Island Press, 2013