Beliefs about Health and Mental Health Traditional Native American Perspective

1. Beliefs about Health and Mental Health Traditional Native American Perspective University of Oklahoma School of Social Work Master’s Advanced Curriculum Project Dr. Lisa Byers (Cherokee) Supported by:

2. Social Work Relevance Health beliefs determine the meaning of illness and service preference Knowledge of Native American traditional concepts of wellness and illness Compare to Western conceptualizations of illness Provide knowledge of traditional healing Impart elements of respect for traditional healing Assessment of health through explanatory models

3. Origin of Illness Across Cultures Prior to beginning PowerPoint have students engage in the ‘Origins of Illness’ In Class Activity

4. Holistic Medicine Wheel Traditional Concept of Wellness1 Spiritual Encompasses Emotional, Mental, Physical, and Spiritual Realms of Self, Others, and the Environment All must be in balance to have health or wellness Emotional Physical Mental

5. Medicine Wheel: Concept of Health Remains Significant2 Big Horn Medicine Wheel Wyoming The Medicine Wheel concept from Native American culture provides a model for whom we are as individuals: We have an intellectual self, a spiritual self, an emotional self, and a physical self. Strength and balance in all quadrants of the Medicine Wheel can produce a strong, positive sense of well-being, whereas imbalance in one or more quadrants can cause symptoms of illness. Addressing issues of imbalance can potentially diminish your patient’s symptoms and enrich their quality of life. - Louis T. Montour, MD, CM; CCFP; ABFPPresented at the Fifth Annual Meeting of the Native Physician Association in Canada, Ottawa, Ontario, August 23-25, 1996.

6. Traditional Concept of Illness1 Illness is the result of imbalance Within the self systems, the family, tribe, or the world An individual may not be living up to their roles or obligations to their self or to the group Bad medicine Symptoms A symptom can occur in any of the realms (emotional, mental, physical, spiritual)

7. Traditional Healing1 Goal-Holistic Treatment Restore balance across all realms within the individual and within relationships Potential Participants Individual, her/his family, and/or clan Individuals that are deemed important to healing process by the person or healer http://xnet.kp.org/permanentejournal/winter00pj/wheel.html

8. Origins of Disease and Medicine A Cherokee example: Traditional Stories of Illness Story tells of how birds, fish, insects, animals, and humans lived in harmony until the humans overcrowded the animals and created weapons to kill them. The was retaliation from the birds, fish, insects, and animals in the form of disease. The plant world responded by offering their leaves, roots, bark to make medicine to save the Cherokees.

9. Traditional Healing Discussion with Client American Indian and Alaska Natives may be reluctant to discuss traditional medicine Protective in past traditional spirituality and healing was considered illegal Current era of exploitation of Native American spirituality and healing

10. Traditional Healing Sources Medicine people are known within the tribe or area Medicine people do not advertise in a commercial manner A client may ask for funds to travel back to see their traditional healer-your agency will need to determine if such travel is fundable If an individual is new to the area and cannot utilize the healer that they have used in the past, here are some options: Contact local Native American social workers or Native American based social service agencies Access individuals who will know the way to access a healer and the protocol

11. “Sometimes a Broken Bone is Just a Broken Bone” Native Americans will not attach every injury with spiritual significance They know that if they break a bone they need to go to the emergency room or a physician Later they may reflect on whether there was a meaning behind the event, if they were distracted by a worry that may have lead to carelessness or not.

12. Social Work Implications Listen to person’s story about their symptoms & illness. Follow Up Questions: What do you believe caused this illness? Who have you seen in the past to help with this kind of illness? Was it whom you preferred to see? Was it helpful? What made it helpful or not helpful? Who would you like to see now?

13. TO STUDENTS: How would you adapt the Explanatory Model questions for a Native American elder? Assessment Questions from Kleinman4 Explanatory Model What do you think caused this? Why do you think it started when it did? What do you think your illness does to you? How does it work? How severe is your illness? Will it have a short or long course? What kind of treatment do you think you should receive? What are the most important results you hope to receive from this treatment? What are the main problems your illness has caused for you? What do you fear most about your illness?

14. References Barlow, A., & Walkup, J.T. (1998). Developing mental health services for Native American children. Child and Adolescent Psychiatric Clinics of North America: The Child Psychiatrist in the Community, 7(3), 555-577. Montour, L.T. (2000, Winter) The medicine wheel: Understanding “problem” patients in primary care. The Permanente Journal , 4(1), 34-39. Cherokee Nation (no date). The origins of disease and medicine. Retrieved August 10, 2008 from http://www.cherokee.org/Culture/Default.aspx?section=culture&culture=literature&cat=PdWeE5zX1DE Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251-58