The Elders Speak: What Indigenous People Know About Health – Lewis Mehl Madrona
I come from a long line of Cherokee people who escaped Andrew Jackson's Trail of Tears and Death, the forced march of our people to Oklahoma which began in 1836.
My ancestors hid in the Appalachian Mountains of Kentucky and slowly assimilated into the white culture –primarily Scottish, also called “hillbillies” – the people famous for bluegrass, fiddle playing, and moonshine. My father’s people were a combination of French Canadian and Oglala Lakota from the Wounded Knee area of South Dakota – a result of the Fur Trade. For most of my generation, fathers were absent or dead, as was mine.
I grew up with my maternal grandmother’s Christianity. I later discovered her beliefs were so far from conventional that they were Cherokee in disguise. I am also a doctor who has been trained in the dominant culture’s healing philosophy and methods at some of its most elite schools. Therefore, I am a bi-cultural person who has seen the best of each culture and the difficulties each has in understanding the other.
In keeping with an aboriginal style of presentation, I will begin with a story about being multicultural in the modern age and about one of the Elders who helped me struggle with these concepts.
When I entered the tipi, Old Ben was in the midst of a story. Old Ben was surviving in the 21st century in the patchwork way common to many contemporary Elders. On the weekends, he led ceremony; during the week, he worked as a printer. Like many modern-day Native Americans, Ben’s background was even more complex — he was a Navajo-Lakota mix living in Hawaii. He had come to Hawaii years before with the military, had started school while serving at Hickam Air Force Base and had stayed.
Like a true resident of the Rainbow State of Hawaii, Ben borrowed freely from all cultures at will, changing the names to fit his audience. His consciousness treated stories in the way that viruses treat DNA. As he heard and recalled stories, he substituted, deleted, and recombined various parts of the stories until he got something brand new – something never before seen or heard.
Ben was telling a story about an ancient one who gave up his voice so that his family might never go hungry. This man was a great healer and storyteller but was perpetually poor. A spirit offered him a trade — his voice and his ability to heal in exchange for prosperity. “The healer’s wife was overjoyed,” Ben was saying. “Finally she would always have meat on their table and the things in life that she felt she deserved for all those many years that she had lived with the healer. A deer brought itself to their lodge and laid itself down for their food. The choicest roots began to grow behind their lodge. Barren bushes grew berries.
“Things were worse for the healer than he could have ever imagined,” Ben continued. “He had not realized how many little things we do in life that are healing. He could not make the softest touch, for these are often more healing than the grandest ceremony. He could not reassure or comfort his wife and children. In fact, there was little he could do, for most of what we do in life is healing to someone or something. Unfortunately, his wife soon grew tired of prosperity, for what is wealth without love? What is prosperity without comfort or joy? What is the satisfaction of freedom from hunger and thirst without gentle companionship? Soon the healer and his family despaired more than ever before.
“This is sort of a variant of ‘the grass is always greener,’” Ben said. “The man was now helpless, for he had lost the capacity to heal himself, and that is what makes us human. His wife vowed to help him, but what could she do? She resolved to take him to all the best healers, even in distant lands, to do whatever it took to make things right again.”
The following three stories about Native Americans show that the dominant culture’s medical model does not always work for indigenous people and can even harm them.
Nancy was 25 years old, pregnant, and quite psychotic. Sometimes she didn’t believe she was pregnant, and other times she did. The GP and the social workers worried that she wouldn’t know when she went into labor and wondered if they should invoke guardianship and control her behavior during the end of her pregnancy. A talking circle was held, and an Elder suspected that Nancy always went for medical care when she had pain. Her physicians agreed. The circle proceeded, and everyone agreed that Nancy would go to the clinic when she had pain, whether or not she thought she was pregnant, and whether or not she thought she was in labor. Nancy’s family rallied around her, including her parents, the baby’s father’s parents, the grandparents on all sides, brothers, sisters, aunts, uncles, cousins. They cared for Nancy 24 hours a day, 7 days a week, and they planned to care for the baby until Nancy was able to care for it. They didn’t see any problems.
The officials in the health-care service, however, saw the problems as quite severe. They were prepared to manage Nancy’s life and baby for as long as they thought necessary. The staff of the health-care service were uncomfortable with taking over without legal orders.
The gulf between ethical systems was obvious: The non-aboriginal people believed that rules, laws, and intervention were required, whereas the aboriginal people believed that families take care of their own and that laws were superfluous. In the end, the health-care people could not get legal orders in time, and the family took care of everything. In six months, Nancy was no longer psychotic, was still surrounded by her family, and was taking care of her baby herself.
Vanessa was in the throes of mild cognitive impairment, close to dementia, and wanted to give away all her money. Her social workers didn’t think this was a good idea because she would not have any money left to care for her in her later years. They wanted a guardianship for her to protect her money. The family’s solution was to get together everyone in the community, let their mother give away the money, and have people in the community give it back. This seemed perfectly logical to everyone in their community because it matched the “give-away” culture that was familiar to everyone. In Vanessa’s culture, it was acceptable and desirable for people periodically to give away their possessions to others knowing that others would do the same and that possessions would return. The sense of ownership was quite different from that in the dominant, white culture. The government social workers were appalled at this solution, but the community was content. The social workers couldn’t believe that anyone would give the money back, and the family couldn’t believe that anyone wouldn’t. Luckily for the family, the government legal system moves so slowly that the family’s plan was working long before orders were written by a judge.
A conflict arose on the reservation in which a younger sister wanted to send her brother to residential treatment off the reservation. The social workers thought this was a good idea because her brother had inhaled too many solvents, had some brain damage, wandered around the reserve, didn’t care for his house very well, and seemed somewhat aimless and possibly dangerous to himself. His other relatives called a community meeting and agreed that they didn’t want the young man removed from the community. They thought he would be easy prey in the big city. They also questioned the motives of his sister, thinking she just wanted his house. A circle was called for discussion, and the consensus was that the young man would be better off being maintained in the village on the reservation. His sister would just have to wait for another opportunity to have a house.
Community members volunteered to help him. The owner of the one restaurant in the village offered to provide him food, and the family agreed to maintain a running tab with the owner so the young man could go there and eat and not have to worry about paying for his meal. They negotiated that most of what he ate had to be nutritious. Other community members agreed to keep an eye on the young man and make sure he didn’t wander too far away into the bush. Everyone in the community was satisfied with the plan, except the sister who wanted the house. It was implemented more quickly than the social workers could protest. Eventually even they realized the plan was working and was as good as one could get. Family members volunteered to help manage the repairs on the house and monitor its condition.
As these three stories show, aboriginal people in North America do not always relate well to the health-care services provided by the dominant culture. The unsatisfactory experience of aboriginal people with contemporary medical care is influenced by the sanctioned ideas and social norms of the dominant culture. In North America, the health-care model of the dominant culture rarely considers indigenous ideas or values when planning or delivering services. Medical services are provided on an individualist model, whereas most First Nations are more collectivist. Health services may create as many problems as they solve due to labelling, assimilationist strategies, and perceived racism.
Dominant-culture models stress caring for one dimension (the physical body), whereas aboriginal views include a more global, balanced worldview, often exemplified by the medicine circle. A non-aboriginal approach to service delivery may actually contribute to “psychic colonization and existential frustration” because one must reject one’s own tendencies in favor of the structures provided by the dominant culture. Current health services may be viewed as supporting individualism and materialism, which undermines aboriginal values because, for aboriginal people, cultural and spiritual needs are as important as physical needs.
A study of aboriginal Elders I conducted about a decade ago speaks to some of the profound differences between notions of healing in aboriginal and dominant cultures.
1. The Elders believed that healing begins with genuine listening. One Elder said, “People tell you what needs to be done if you listen. We talk in order to listen.” All behavior is framed within stories. When you have everyone’s stories, you can understand what everyone is thinking and feeling, what their operative beliefs and desires are. Then, we can negotiate so that everyone feels respected and heard. Elders spoke about suffering existing within the context of a story, for all we are is story. In explanation, they said that all that is left when we die are the stories told about us. They believed that the self that we believe we are is just the story we tell ourselves to make sense of all the stories that have been told about us. The story lives us as we live the story. They stressed that, to understand a situation, putting it in the context of all the stories that are being told is necessary. To make a healing decision, we must hear as many stories that are being or have been told about the situation as is possible. We can never hear them all, but the more we hear, the more healing we can be.
Several Elders commented that most of the professionals they met were convinced of the superiority of their healing methods compared to those of the Elders. When they encountered these attitudes, the Elders acted “stupid.” To them, ethical decision-making involved listening, which implied respect, and respect mattered.
2. Healing is relational. None of the Elders believed in abstract principles. They believed that good decisions arise through a process of relational, social interaction. They saw each person as contributing importantly to a final decision. They saw health decisions arising through interaction of all shareholders in the outcome, through a process of dialogue, embedded in long-term relationships. The Elders did not need books or case examples to arrive at their conclusions.
The Elders believed that we construct a story about problematic situations based on the results of our reflections and then perform that story in the world. They agreed that the performance of our story gives us corrective feedback from the others whom we encounter that can steer us in the right direction. They did not believe a truly correct decision could occur without interacting with others to get feedback about the story we are constructing.
3. Healing consists of helping people find their own solutions rather than telling them what to do. The Elders were consistent in their belief that imposing an answer on someone or a family or a community was decidedly unethical. People must find their own answers. They must be empowered to receive their own divine guidance. They believed that the helper or Elder was only present to facilitate the conversation. The Elders’ perspective was consistent with the view that increasing emphasis on the individual in communities and increasing isolation of problems from group concern leads to social disruption and, consequently, prohibits the formation and utilization of the necessary social relationships for the development of local solutions.
4. Healing requires selfless intent. Time and again, the Elders emphasized the power of intent and the need for selfless intent. For some, it took the form of never profiting. All insisted that it was necessary to hold the highest good of the person or people involved in the question in the highest light above all considerations of personal reward.
5. Healing must be independent from politics. The Elders were insistent that laws, politics, and the medical establishment should not influence making the right decision.
6. Empowerment is better than instruction. Empowerment leads to people making their voices heard, regardless of other considerations. When all voices are heard, then the right action can result from that dialogue.
7. Health exists within the community. Community contains the wisdom, which the individual lacks. Collective minds offer more wisdom than individual minds. This is why, some Elders said, ceremony is done with more than one person. Everyone’s prayers and intents matter.
8. Health decisions are ultimately spiritual decisions. The goal for all deliberations was to connect with the spiritual dimension and to receive guidance and direction. The spiritual dimension represents the “deepest” level from which guidance can be received. The spirit’s willingness to help was a necessary ingredient.
What I have learned from talking to the Elders is that the more knowledge that providers have of their own culture and of their clients’ cultures, the more valuable is their service delivery, because they are aware of cultural differences and can honor their values. They can better understand the people being served and take more account of the variety of aboriginal cultures found on this continent (North America has more than 500 identifiable tribal groups). Bicultural people can provide an important link to mainstream culture, but bicultural personhood is hard to come by. When it is attained, it can provide an important bridge between integration and differentiation.
So, what happened to the man in Old Ben’s Story? I’ll bet you thought I’d never tell you. As you can imagine, the man got very sad and no one could console him. One day, he gathered his things and left his dwelling and walked into the woods. He walked toward the setting sun. He was sad for he thought he would never see his family again. He planned to walk until he died, for he had no reason to live. He was no use to his family. The prosperity he had gained for them would outlast him.
That first night he slept in a cave in the forest. He smelled the faint odor of bear but not recently and not strongly. Outside the cave was a rust-orange needled tree. Around it stood stout pine trees, their needles thick spikes. The trees seemed to march up the side of a hill. One would have to be sure-footed to get to the top of that hill. The man decided to go for it; to give it his all and make it up the hill. Afterall, what did he have to lose? He had already lost it all.
Up he went and the trees waited for him. The wind spoke. The man was hungry for voice; for the healing power of sound which no longer moved him. He was unsure what he would find. The thought he could hear the murmurs of the branches. Desire moved him. A dream of restoration. A vision that he could be healing again. The hill was getting so steep that he had to grab onto the branches to pull himself up. He thought he saw the Little People from the corner of his eye. He was almost to the top. Perhaps it would be a crazed beast that awaited him? When he reached the top, it was just an Aspen tree at the top of the world, and across the valley on the next hill, stood a Bear.
The Bear beckoned him to come. She waved her arm and called him to her. He came. The going was easier. He made quick time. He was almost ahead of himself when he arrived. “Kill me,”said the Bear.
The man began to cry. “I can no longer heal, but I will not harm,” he said. “You are an Old One, and I cannot harm you.”
“Kill me and I will come back to life,” said the Bear. “Stick your knife into my heart and leave it.” Carrying his sins on his hands, the man struck the Bear through the heart. The Bear staggered backward. The knife traveled through it and she spit it from her mouth, catching it in her paw. “I am not a saint,” said the Bear, but I will make you well. I will stick this knife in your heart and you will be reborn as I was.” The man braced himself to die. That’s what he wanted. He felt the sharp pain of the knife passing through his ribs into his heart. His consciousness fluttered, wings of a butterfly. Surprisingly he found himself spitting out the knife. “Now you can be healing again,” said the Bear. “I have no idea what will happen to your prosperity. That’s another department. Not mine. Go home and be healing again.”
Gratefully, the man turned and walked in the direction from which he came, wondering what awaited him at home. I will let you wonder, also. Maybe every possibility awaited him and you must choose one.
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Lewis Mehl-Madrona, M.D., is the author of Coyote Medicine, Coyote Healing, and Coyote Wisdom, focusing on what Native culture has to offer the modern world. He has also written Narrative Medicine; Healing the Mind through the Power of Story: the Promise of Narrative Psychiatry; and his most recent book, with Barbara Mainguy, Remapping Your Mind: The Neuroscience of Self-Transformation through Story. He graduated from Stanford University School of Medicine and completed his residencies in family medicine and in psychiatry at the University of Vermont College of Medicine. He has been on the faculties of several medical schools, most recently as associate professor of family medicine at the University of New England.