Traditional Healing Practices in Mental Health Jeff King, PhD NAMI National Convention Seattle, WA June 27-30, 2012

1. Traditional Healing Practices in Mental Health Jeff King, PhD NAMI National Convention Seattle, WA June 27-30, 2012 Center for Cross-Cultural ResearchWestern Washington University First Nations Behavioral Health Association

2. How did non-Western cultures diagnose and treat those in their communities before Western contact? How effective were they? How have we been socialized to think about these types of practices?

3. VALUES OF WESTERN SCIENTIFIC METHODOLOGY • Linear reasoning • Scientific method • Objective knowledge • Assumes its science is superior to other ways of knowing • Individualistic • Mastery and control (power over)

4. For example: Former American Psychological Association president, Alan Kazdin, stated, “We want to develop EBT’s [Evidence Based Treatments] for individuals of diverse ethnicities and cultures, not only within our country or continent but for diverse peoples of the world.” (Kazdin, 2008, p. 208).

5. There are three major implications to this statement that reflect this sense of Western scientific superiority: 1. “We” implies Western scientists; 2. “develop EBT’s …” implies that non-served cultures have not developed effective practices; and, 3. implies that these countries and cultures have not been actively involved in addressing the psychological needs of their people over time. This is all well-intentioned, yet extremely dangerous, as it relegates all other ways of knowing to an inferior status and ignores thousands of years by which ideas from other cultures and countries successfully and effectively engaged in indigenous, non-western healing practices.

6. CULTURAL DYNAMIC RESULTING FROM EPISTEMOLOGICAL SUPERIORITY—Power and uni-directionality. Western European Science We will study you from our point of view. Non-Western Cultures You need to come around to our way of thinking.

7. Consequences: Disparitiesin mental health service delivery, quality, usage, & outcomes have not decreased in the least in the past 25 years (Isaacs, Huang, Hernandez & Echo-Hawk, 2005; The President's New Freedom Commission on Mental Health, 2003).

8. Clearly, this is an imbalance of power: • disrupts authentic communication • creates a superior-inferior dynamic • damages the well-being of the “inferior” • bolsters the status of the “superior” • creates distrust • subtly undermines the status of the • “inferior” culture • effects colonization (unawares).

9. The 2001 Surgeon General’s report found that between 1986 and 2001, 9,266 participants were included in randomized controlled trials evaluating the efficacy of interventions for bipolar disorder, schizophrenia, depression, and ADHD, and of these participants there were only 561 African Americans (6 percent); 99 Latinos (1 percent); 11 Asian Americans/Pacific Islanders (0.1 percent), and 0 American Indians/ Alaska Natives identified; and not a single study analyzed the efficacy of the treatment by ethnicity.

10. This process manifests itself across most, if not all life domains. For psychology here are some: (These are all anchored in a Western • World view.) • Education Where in this is our voice? • Training • Supervision • Policy • Ethics • Treatment • Assessment • Research

11. Wilhelm Wundt - father of psychology William James - father of American psychology Sigmund Freud Carl Jung Ivan Pavlov Abraham Maslow Carl Rogers B. F. Skinner

12. Given this, does it not make more sense that our current “cultural adaptations” of research designs, assessments, and interventions simply Western concepts dressed up in (modified to) culture? That is what is acceptable?

13. THE HEALING PROCESS AND CULTURE Psychology is both a science and an art Psychology is imbedded within the scientific culture and thus embedded in Western European systems of thought Our ethnocentrism has limited our ability to observe phenomena from other cultural views Cross-Cultural psychology calls for the acceptance, understanding and integration of other cultural views

14. THE HEALING PROCESS AND CULTURE Christina – grief & depression-acupuncture Robert Bergman—report of cured schizophrenia Navajo medicine Fernando– curandera Patricia—dissociative disorder?

15. THE HEALING PROCESS AND CULTURE Clinical and theoretical implications: • Healing manifests itself in the context of culture. • There are events and processes related to healing that are currently outside of our psychotherapeutic theories • Healing is greater than the “sum of the parts” (e.g., Jung, Rogers) • People get better in a manner congruent with their own culture

16. Western European Cultural ValuesWHAT IS THE RELATIONSHIP HUMAN BEINGS HAVE TO THE REST OF THE WORLD (CREATION)?-SUPERIOR, POWER OVERWHAT IS OUR RELATIONSHIP TO THE LAND?-SEPARATE, TO BE CONQUERED, MASTEREDWHAT IS OUR BASIC ACTIVITY IN THE WORLD?-DOINGWHAT IS OUR RELATIONSHIP TO TIME?-FUTURE-ORIENTEDWHAT IS OUR BASIS FOR SUCCESS?-PERSONAL GAIN, STATUS, WEALTH, PROPERTYWHAT IS OUR SOURCE OF MOTIVATION?-SELFWHAT ARE THE CHARACTERISTICS OF A HEALTHY PERSON?-Independent, Autonomous, Self-made, “I can do it myself”, Assertive, Vocal, Self-confident, etc.

17. People in the “superior to creation” world view will see nature more as a curiosity and challenge to tame or conquer and thus approach the world with an attitude of superiority and view all of life as pointing to them. While, Indigenous People will approach life with a respectful and honoring attitude, and view each aspect as containing meaning and lessons for living together, each aspect of life having meaning in itself.

18. Reinhold Niebuhr stated that those who hold to power in this way assume both moral and intellectual superiority over the “other.” It follows that if one culture holds the “higher truth” then there is no need to try to understand the “other.” Rather one would expect them to come around to your way of thinking and living. “Civilizing the Native” is an example of this dynamic.

19. Non-Western peoples have had to make effort to counteract this process by reclaiming their own ways of assessing and treating—based on their own traditional values. Research has consistently shown that “culture is strength” or that it provides a “protective factor” (King, 1993).

20. Typical Indigenous Cultural ValuesWHAT IS THE RELATIONSHIP HUMAN BEINGS HAVE TO THE REST OF THE WORLD (CREATION)?-EQUAL, SHARED POWER WHAT IS OUR RELATIONSHIP TO THE LAND? -LEARNERS, RESPECTFUL, FAMILY WHAT IS OUR BASIC ACTIVITY IN THE WORLD?-BEING WHAT IS OUR RELATIONSHIP TO TIME?-PRESENT-ORIENTEDWHAT IS OUR BASIS FOR SUCCESS?-CONNECTION TO TRIBE, COMMUNITY, FAMILY, NATURE WHAT IS OUR SOURCE OF MOTIVATION?-OUR PURPOSE TO THE TRIBE, COMMUNITY, FAMILY, EARTHWHAT ARE THE CHARACTERISTICS OF A HEALTHY PERSON?-INTERDEPENDENT, KNOWS HOW TO ACT IN RELATION TO OTHERS, QUIET, RESPECTFUL

21. “For the present, the indigenous way of seeing things like traditional Indians is…incongruent with the linear world [of science]. The linear mind looks for cause and effect, and the Indian mind seeks to comprehend relationships.” (Fixico, 2003, p. 8)-Seminole-Creek

22. In… [Western]…ways of thinking, the ego, or the “self,” is at the center of life, and the perception of all things surrounding are in relationship to the individual person…Specifically, egocentric Americans perceive themselves [and their science] as the center of activity, and they act and view others from their focal point. “ (Fixico, 2003)

23. When  the late Vine Deloria, Jr., a respected American Indian scholar, was asked during an interview about the fundamental difference between the Western and indigenous ways of life, he replied: "I think the primary difference is that Indians experience and relate to a living universe, whereas Western people--especially scientists--reduce all things, living or not, to objects." (Deloria, 2000) Lakota

24. “Our ancestors lived in a spiritual universe. We are still conscious of it but many immigrants from Europe do not experience it because they do not see that all things are imbued with spirit. The world that the Indian knew was changed after two waves of immigrants, first from Spain then England, brought another culture and disregarded Indian ways that respected Creator's Earth. The [system] that now governs us has no relationship to the land that sustains us.”   -Phillip Duran (Tigua Pueblo)

25. The difference in world views constitutes, at this time, an insurmountable, fundamental difference. Given these differences, we must re-evaluate our use of scientific method in the context of non-Western cultures.

26. WHAT IS TO BE DONE? Western science needs to become de- centralized—move off its center and its notions of superiority. A greater openness by science for other ways of knowing (traditional healing) must emerge, with the recognition that they are to be treated with equal respect.

27. WHAT IS TO BE DONE? But, we can’t wait for that. Healing means restoration to wholeness-this includes cultural wholeness as well Within an indigenous context this includes one’s culture. George Coser, a Muscogee medicine man who worked in a substance abuse treatment center said that native people who chose to connect to their culture as part of the treatment were less likely to relapse. There are a lot of data as well as stories that indicate the same thing.

28. WHAT IS TO BE DONE? We need to be actively disentangling ourselves from the existing standards based on White Western epistemologies and reclaim our own. We need to ask the critical questions in settings we find ourselves. Part of reclaiming is that we need to talk to our elders, our traditional healers to discover our histories and ways of relating to the world. “How did they treat behavioral problems? How did they treat depression or psychosis? etc.”

29. Practice-Based Evidence Individuals within the cultural competence movement believe that an over-emphasis on the development and implementation of EBPs decreases attention to cultural variations in service delivery and tends to invalidate and/or exclude culturally specific interventions and traditional healing practices utilized in communities of color (Isaacs et al., 2005). A concept developed to address this concern is practice-based evidence (PBE). PBE is defined as a set of unique and inherent cultural practices that have non-traditional evidence based upon community consensus (Martinez, 2008). PBE addresses the therapeutic and healing needs of individuals and families within a culturally specific framework. While PBE practices may not have an empirical evidence base, Martinez (2007) points out that they are valuable for being responsive to and respectful of the community, prioritizing individualized care.

30. Terms for health in non-Western cultures Japanese—wa Chinese—he her Navajo—hozho African American (Ghana) San Kofa

31. In Dine’the term “Sa’ah naaghaii bik’eh hózhó” means well-being, which focuses on balance in living. It is about health, long life, happiness, wisdom, knowledge, harmony, the mundane and the divine. For the Dine’, hózhó represents a synthetic and living description of what life on the surface of planet Earth should be, from birth until death at an old age.

32. WHO and its Member States cooperate to promote the use of traditional medicine for health care. The collaboration aims to: • support and integrate traditional medicine into national health systems in combination with national policy and regulation for products, practices and providers to ensure safety and quality; • ensure the use of safe, effective and quality products and practices, based on available evidence; • acknowledge traditional medicine as part of primary health care, to increase access to care and preserve knowledge and resources; • ensure patient safety by upgrading the skills and knowledge of traditional medicine providers.

33. Chinese pulse diagnosis “Chi meridians acupuncture points

34. Questions? Contact information: jeffrey.king@wwu.edu

35. Mvto! (Thank you.)