We report the results of involving traditional healing elders (THE) in the clinical care of aboriginal families who were involved in domestic violence in the context of a clinical case series of referrals made for domestic violence.
Psychiatric consultations were requested from senior author L.M.M. for 113 aboriginal individuals involved with domestic violence as recipients or perpetrators (or both) between July 2005 and October 2008. As part of their clinical care, all were encouraged to meet with a THE, with 69 agreeing to do so. The My Medical Outcomes Profile 2 scale was being used as a clinical instrument to document effectiveness. Elders used traditional cultural stories and aboriginal spirituality with individuals, couples, and families to transform the conditions underlying domestic violence.
For those people who met with the THE, a statistically significant change (p
Although a number of authors have commented on what mental health practitioners should be taught to be effective and appropriate with indigenous people, rarely have traditional healers been asked for their views. This paper explores what a diverse group of traditional healing elders believe are the important attributes for mental health providers to embrace and what principles they should adopt to guide their training. How indigenous people understand the meaning of mental health is also examined. The research presented was conducted in preparation for developing a cross-cultural training program for human service providers that would include traditional elders as community mentors and adjunct faculty on equal status with academically trained faculty. The goal is to identify and summarize the core values and principles needed to train mental health providers to work in harmony with traditional healers. The term indigenous used in this paper refers to people who have lived in a place long enough to develop local knowledge and practices about that place, even though they might not have been the original inhabitants. For example, the Dene in Arizona are indigenous even though they have only occupied that area from about 1100 ad. Last, the paper is presented in an indigenous way, first by situating the author, telling a story, explaining the methodology, describing the elders and what they said, and ending with a story to dramatize the conclusions as indigenous elders would do.
In the conventional view of bipolar disorder, life-long treatment with pharmaceuticals is assumed. This paper presents an overview of 24 narratives from people in the author's practice who have successfully managed and thrived without pharmacological treatment. For comparison purposes, 24 patients who could not manage without medication (even though some tried) were selected from the author's practice and matched for age, sex, socioeconomic status, and years of illness. Comparisons between the stories reveal that recovery without medication requires more substantial life change than does management with medication. Such non-medicated recovery becomes an all-encompassing life project. The patients who follow this path make major life changes and maintain them. The worldview of non-medicated bipolar patients differs, in that their struggle for recovery provides them with meaning and purpose, which is, in itself, healing. These patients avoid health practitioners who would criticize their alternative approach. They are compared to patients who do not manage well without medication who nevertheless try to manage their condition with herbs or vitamins or other alternative therapies and are unable to do so. Accurate appraisal of illness versus denial of illness emerges as the guiding theme. It may be important to recognize a successful strategy for living without medication compared with strategies of denial or flights into herbs and/or vitamins that will ultimately not succeed. Indigenous (or aboriginal) people, in particular, may reject the conventional psychiatric model in favor of a more holistic approach more congruent with their cultural healing paradigms.
First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder-based and Aboriginal culture-based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation-storytelling-experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples.
The commonalities are described of 47 people who sought traditional aboriginal healers for help with their cancer. All had 10% or less chance of survival at 5 years given the site and stage of their cancer from actuarial table calculations.
The subjects were compared to a similar group of people who were also working with aboriginal healers and who did not survive past 5 years. Narratives were obtained from the people before and after their work with the healer. These stories were enriched through interviews with family members, friends, health care providers, and the healers themselves, whenever possible. Panels of naïve medical students, graduate students, patients, and health care providers were used to evaluate the stories and to pick themes that consistently emerged (dimension analysis). Once stable dimensions emerged, scenarios were developed to rate patients along these dimensions from "1" to "5." New panels did the ratings, with at least 3 panels of 3 people per narrative. Comparisons were made between these 2 groups of people, and differences emerged on the dimensions of Present-centeredness; Forgiveness of others; Release of blame, bitterness, and chronic anger; Orientation to process versus outcome; Sense of Humor; Refusal to accept death as immediate prognosis; Plausible (to the patient, his or her family, and the healers) explanation for why he or she got well, including a story reflecting a belief about how he or she can stay well; Supportive community who believes in the person's cure and protects the person from outsiders who think the person will die; People experience a quantum change, in which major improvements in self-esteem and quality of relationships occurs; and Spiritual transformation.
The 2 groups of people reported equal increases on the dimensions of Sense of Meaning and Purpose and Faith and Hope, which may be intrinsic to the style of healing of aboriginal elders.
Culturally defined healers operate in most of the world, and to various degrees, blend traditional healing practices with those of the dominant religion in the region. They practice more or less openly and more or less in conjunction with science-based health professionals. Nonindigenous peoples are seeking out these healers more often, especially for conditions that carry dire prognoses, such as cancer, and usually after science-based medicine has failed. Little is known about the medical outcomes of people who seek Native North American healing, which is thought by its practitioners to work largely through spiritual means.
This study explored the narratives produced through interviews and writings of people working with traditional Aboriginal healers in Canada to assess the degree of spiritual transformation and to determine whether a relationship might exist between that transformation and subsequent changes in medical outcome.
Before and after participation in traditional healing practices, participants were interviewed within a narrative inquiry framework and also wrote stories about their lives, their experiences of working with traditional healers, and the changes that the interactions produced. The current study used a variety of traditional healers who lived in Alberta, Saskatchewan, and Manitoba.
Urban and Rural Reserves of the Canadian Prairie Provinces.
One hundred fifty non-Native individuals requested help from Dr Mehl-Madrona in finding traditional Aboriginal healing and spiritual practitioners and agreed to participate in this study of the effects of their work with the healers.
The healers used methods derived from their specific cultural traditions, though all commonly used storytelling, These methods included traditional Aboriginal ceremonies and sweat lodge ceremonies, as well as other diagnosing ceremonies, such as the shaking tent among the Ojibway or the yuwipi ceremony of the Dakota, Nakota, and Lakota, and sacred-pipe-related practices.
The research team used a combination of grounded theory modified from a critical constructivist point of view and narrative analysis to rate the degree of spiritual transformation experienced. Medical outcome was measured by a 5-point Likert scale and was confirmed with medical practitioners and other family members.
A 5-year follow-up revealed that 44 of the reports were assessed as showing profound levels of persistent spiritual transformation, defined as a sudden and powerful improvement in the spiritual dimension of their lives. The level of spiritual transformation achieved through interaction with healers was associated in a doseresponse relationship with subsequent improvement in medical illness in 134 of 155 people (P
To explore the experiences of health care practitioners working with Aboriginal clients recovering from acquired brain injury (ABI).
Participatory research design using qualitative methods.
Fourteen in-depth, semi-structured interviews were conducted. The Framework Method of analysis was used to uncover emerging themes.
Five main categories emerged: practitioners' experience with brain injury, practitioners' experience with Aboriginal clients, specialized needs of Aboriginal clients recovering from brain injury, culturally sensitive care and traditional healing methods. These categories were then further divided into emergent themes and sub-themes where applicable, with particular emphasis on the specialized needs of Aboriginal clients.
Each emergent theme highlighted key challenges experienced by Aboriginal peoples recovering from ABI. A key challenge was that protocols for rehabilitation and discharge planning are often lacking for clients living on reserves or in remote communities. Other challenges included lack of social support; difficulty of travel and socio-cultural factors associated with post-acute care; and concurrent disorders.
Results suggest that developing reasonable protocols for discharge planning of Aboriginal clients living on reserves and/or remote communities should be considered a priority.
To explore the barriers and enablers surrounding the transition from health care to home community settings for Aboriginal clients recovering from acquired brain injuries (ABI) in northwestern Ontario.
Participatory research design using qualitative methods.
Focus groups conducted with clients with ABI, their caregivers and hospital and community health-care workers. The Framework Method of analysis was used to uncover emerging themes.
Six main categories emerged: ABI diagnosis accuracy, acute service delivery and hospital care, transition from hospital to homecare services, transition from hospital to community services, participant suggestions to improve service delivery and transition, and views on traditional healing methods during recovery.
A lack of awareness, education and resources were acknowledged as key challenges to successful transitioning by clients and healthcare providers. Geographical isolation of the communities was highlighted as a barrier to accessibility of services and programmes, but the community was also regarded as an important source of social support. The development of educational and screening tools and needs assessments of remote communities were identified to be strategies that may improve transitions.
Findings demonstrate that the structure of rehabilitation and discharge processes for Aboriginal clients living on reserves or in remote communities are of great concern and warrants further research.