David Walker on Indigenous Peoples and Western Mental Health
On the future of mental health
Posted Apr 24, 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with David Edward Walker
EM: You contend that Western mental health systems are a source of oppression for Indigenous People. Why do you say that?
DW: Today’s Western mental health systems in Indigenous communities have a lengthy history of complicity in oppression. In the U.S., insane asylums developed in the mid 19th century to incarcerate Native people resistant to forced assimilation policies or displaced and overwhelmed by ongoing land theft and cultural disruption. Academic social scientists inspiring the international eugenics movement fortified the racist rationales for Native genocide and cultural destruction embedded within such policies.
Race psychologists of the early 20th century were quick to enter American Indian boarding schools and actively sought to demonstrate the inferior status of the 50 to 70 percent of Native children coerced or kidnapped away from caretakers, often for their entire childhood. I’ve had the humbling experience of counseling with elders still struggling with memories of being lassoed and tied by missionaries, raped in boarding schools, or who’d attempted suicide while inside such places.
Mental hygienists had a major role in plotting the boarding schools’ limited educational curricula, which often presupposed students merited only lives of manual labor and domestic servitude. Their activities disrupted important bonds between loved ones, corrupted family ways for generations thereafter, and set students up for lives of despondency, poverty and dependency on social welfare when they returned home. In dialogues with Indigenous people in other places around the world, I’ve heard them speak of similar oppressive forces impinging upon their communities and cultural ways.
The contemporary Western mental health system in Indigenous communities has a social amnesia for its complicity. The intergenerational reactions of today’s Native community to chronic marginalization, racism, land theft, rape and violence, family disruption, and destruction of language are currently reframed into psychiatric labels stigmatizing individuals. The profitable collusion with pharmaceutical manufacturers in providing alleged “treatments” for these contrived pseudo-disorders is a means of sedating and tranquilizing what are actually reactions to oppression. It may fit Western culture to attempt to indoctrinate people to the idea that they are chemically imbalanced or brain-damaged or suffering from defective thinking, but this view is often very foreign to an Indigenous perspective, and of course, deceptive too.
For example, current Western mental health providers meeting up with an Indigenous person would be unlikely to say: “Well, this man feels mentally and emotionally sickened by colonizers who’ve stolen ancestral land from beneath his feet, destroyed cherished ways of his culture, brought alcohol, drugs, and violence into the lives of his grandparents, parents, aunties, uncles, and children, and marginalized his community as inferior and subhuman.” Additionally, there are no concepts that allow such providers to assist Native people to heal from a disorder of Western culture that promotes violence without culpability, brutality over compassion and selfishness over cooperation.
Instead, the World Health Organization’s Mental Health Action Plan of 2013 through 2020 proposes Indigenous communities are “vulnerable” to “mental disorders” due to their “situation and environment,” a pretty vague depiction if you ask me. According to WHO, individual members of these communities should therefore be labeled using dubious Western systems like ICD or DSM and provided “greater access” to psychiatric medications and electroconvulsive therapy. In this way, Indigenous suffering and reactivity related to oppression continues to be obscured or made invisible by an emerging, globally dominant Western mental health vision. I consider that oppressive.
EM: You've called Attention Deficit Hyperactivity Disorder (ADHD) the "new Feeblemindedness of American Indian children." What do you mean by that?
DW: Tuning out and misbehaving in relation to the stultifying, manualized, test-anxiety ridden public education system is entirely understandable, and that’s where ADHD kids are often first “detected.” If one looks at the social amnesia of today’s mental health system, you’ll soon discover that current ideas and concepts have many historical echoes. There’s little attention given to the fact that newer ideas in Western mental health are often merely updated language.
For example, during the height of the American Indian boarding school era in the 1930s and 1940s, the term “feebleminded” was used to describe children considered “morally defective” as a result of being too active or impulsive, nonconformist, inattentive, or rebellious. In this way, such children were maligned and segregated from whatever limited opportunities were available to others considered to be their superiors.
When we look at today’s public education system in the U.S., which has continued to fail Native children, we find the current epidemic ADHD diagnosis began in Indian Country in the late 1990s. It is only in the last 10 years that the high rate of U.S. ADHD diagnosis in other children has even begun to catch up.
The fact that Native children remain more than twice as likely to end up in special education classrooms than children from other ethnic backgrounds speaks to the continuity of historical segregation and their stigmatizing as uneducable by the U.S. mental health system. ADHD, therefore, continues a process that “feeblemindedness” began. This process was so effective by the late 1960s that surveys of emerging teachers revealed the vast majority were reluctant to teach American Indian kids. Even today, it remains difficult to recruit quality educators toward the beleaguered American Indian education system in the U.S.
I’ve written in more detail on this topic in a recent article for Indian Country Today Media, “Betrayal by Label: The Feebleminded, ADHD Native Child.”
EM: What was the Hiawatha Asylum for Insane Indians? Who ended up there and how did it come to be shut down? What does it teach us about mental health systems in Indian Country today?
DW: The Hiawatha Asylum for Insane Indians, also known as the Canton Asylum, was the only such institution dedicated to incarcerating American Indians. It operated in Canton, South Dakota from the early 1900s until its closure under scandal in 1933. During its period of operation, many Native people resistant to forced assimilation policies or displaced or debilitated by cultural upheaval were sent there for the rest of their lives.
I first became aware of Hiawatha in 2001 through a wonderful article, “Wild Indians,” by psychiatric survivor activist Pemina Yellowbird of the Three Affiliated Tribes of the Mandan, Hidatsa and Arikara Nations. At that time, I was struggling with the mental health ideologies of the Indian Health Service where I worked, and her understanding of the Asylum and its inmates helped me to recognize the darker side of my own profession in an intergenerational context.
Numerous Native U.S. veterans suffering from “shell shock” during World War I ended up living the remainder of their days at Hiawatha Asylum. It’s sad to discover they’d volunteered to serve a country that didn’t yet recognize them as citizens, but truly disturbing to consider early psychologists instituting the Army Alpha-Beta tests had facilitated the pre-selection of these soldiers to endure the front-line combat from which they came to suffer.
After I came to teach at a professional school in Seattle, I was fortunate to secure a small grant that allowed me to obtain a collection of Hiawatha inmate records from the National Archives and Records Administration (NARA). As many other researchers had already begun working to understand the horrific conditions and death that occurred there over the years, I decided to concentrate on learning about the people therein.
I selected two of these inmate files for my article, “‘A Living Burial’: Inside the Hiawatha Asylum for Insane Indians,” which was published by Indian Country Today in November 2015.
EM: More broadly, what are your thoughts on the current, dominant paradigm of diagnosing and treating mental disorders and the use of so-called psychiatric medication to treat mental disorders in children, teens and adults?
DW: During my graduate school education in the late 1980s, I had the pleasure of briefly meeting Dr. Thomas Szasz, the controversial psychiatric critic who passed away only a couple of years ago. My mentors at the University of Detroit were influenced by Dr. Szasz and I became inspired by both his and their skepticism of mental health ideas and systems.
I did my dissertation in what was then called “cross-cultural psychology,” an unusual choice for a clinical psychology doctoral student. I’ve remained fascinated by the centrality of culture beneath so many ideas in psychology. The dominant thought pervading mental health practices in the 1990s was reductionist neural science and the ubiquitous brain scan, so my interests were quite out of step. I’ve always seen the popularity of this reductionist view as an American cultural shift towards denying the depth of human beings and their relationships. My views tended to push me toward the fringe of my profession.
Psychologists often don’t have the opportunity of reflecting upon what they do through the lens of cultural difference. I guess I sought this kind of experience out purposely, and I got socked in the teeth with it after coming to work for the Indian Health Service in 2000 on the sacred land of the Fourteen Confederated Tribes and Bands of the Yakama Nation in central Washington.
The Yakama Nation community is fiercely independent, and its people strategized deliberately to defend and preserve their language and ways against oppressive forces. Of course, oppressive events have taken their toll, but the resiliency of the people has helped them to survive. My gradual acceptance by community members changed me immeasurably, and I’m forever indebted to have been helped to heal from certain coercive and toxic ideas I’d internalized. The cohesion of the Yakama people, their traditional spiritual ways, and their values regarding sharing, honesty, respect, courage, and leadership as giving, allowed me to recognize the woundedness and loneliness of the culture in which I was raised, and the manner to which my own profession colludes with pressuring people to conform to it.
I’ve come to view current dominant psychiatric models of the Western mental health system as hurtful for many people, as a genuine threat to their wellbeing, and as a coercive cultural agent bent upon sustaining social conformity, hyperproductivity, vacuous materialism, individualist isolation, and emotional numbness. The power of Big Pharma is enhanced by the pain such cultural demands create.
I admire the spirit of psychologist Ignacio Martín-Baró, who was assassinated in 1989 by a U.S.-sponsored Salvadoran death squad for daring to speak these kinds of ideas. Perhaps more people are becoming able to listen to them nowadays. Toward that end, I recommend a recent book by Mary Watkins and Helene Shulman called Toward Psychologies of Liberation. They are helping to point out a direction we need to think about and act upon regarding mental health reform.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
DW: Well, I hope I’d be willing to sacrifice my time or preoccupation with the cultural imperatives of doing, doing, doing, so as to focus my attention on someone I professed to love. I’d offer a hug and concentrate on sympathizing with what they feel, try to consciously exchange places with them, and see life through their eyes. I might tell them how much it means to me to have them share what they feel with me, and note to them that I’ve suffered too. Maybe I’d offer a poem or a song for them or a homemade pie.
Perhaps these things sound banal or trite. I suggest that in the culture many of us inhabit the connections people used to cherish and value are currently under siege. It’s become easier and even appropriate to dismiss, minimize, or push away another’s suffering, especially toward the mental health system. I feel that in our own time we’re witnessing the gradual abandonment of the institution of friendship. We’re being taught to open our smartphones and turn away from the real humans before us. Friendship is currently being remade into a set of online virtual entities for which we pay money to interact. Additionally, we’re being taught to view the expression of intense emotion as pathological and threatening and scary, particularly if it involves talking in crazy or even psychotic ways.
I believe human love is likely the foundation upon which the “nonspecific factors” that constitute the bulk of psychotherapy effectiveness are built. It may seem like heresy for me to say, but good psychotherapists are taught to place the other person at the center of the relationship, as though the rest of us shouldn’t concern ourselves with such an idea. The professionalization and commodification of love and friendship over the last two centuries has disempowered a longing that lies dormant in the rest of us. Our own abilities to help and even to heal one another’s emotional suffering have been with us for thousands upon thousands of generations.
So all I’m saying is that if I had a loved one or close friend in emotional or mental distress reach out to me, I’d first try hard to be a good friend or relative in response and to understand how I myself might be of use in helping disentangle despair and anguish through my own expression of love. This activity deepens me as a person and may deepen them too. It also helps to restore and refresh what is being actively eroded in our humanity.
Now if the interaction between us becomes too overwhelming for me or otherwise leads to the idea that making use of a psychotherapist could be of more help, I’d encourage my loved one to seek someone who recognizes the importance of intimate connection and collaboration. This helping person would realize the uselessness and potential stigma of mental health labels and openly question the pseudo-science currently dominating mental health practice. They would view what they do more realistically as a close human encounter mixed with philosophical ideas.
They wouldn’t push my loved one toward becoming more numb through medication or behavioral techniques but instead help toward reducing reactivity and suffering. This special person would be able to tolerate the presence of anguish and to listen to very difficult experiences while helping to facilitate putting pain into words, encouraging others to find peace and self-acceptance. He or she would be honest, trustworthy, respectful, and of the highest integrity.
You’ll notice I haven’t mentioned a particular psychotherapeutic orientation or an “evidence-based approach.” From a technical standpoint, I consider the qualities I’ve mentioned as necessary to any approach that responds to traumatic stress, which I define quite widely as any event or events overwhelming to one’s internal and external resources. Traumatic stress seems fundamental to anything the mental health system concerns itself with from the mildest distractibility and depressed mood to psychosis. I see such stress as a universal factor that “teaches” painful mental and emotional reactivity, which constitutes a kind of signaling behavior toward both oneself and others about needs for intense support and reassurance.
To me, all the so-called mental health “disorders” not readily identifiable as brain injury or toxicity are by default cultural ways of labeling, even maligning individual social fears, malaise, alienation, rejection, or reactions to assault. Whether a child is responding to the stress of negative comparison to peers, resisting being coerced toward dull, difficult tasks, or preoccupied over fights between mom and dad, he or she is accused of being “ADHD.”
Schizophrenia, a questionable label for a diverse set of behaviors that depict a fragmenting of culturally sanctioned boundaries between self and others, seems to often emerge within the context of stressors resulting in individual isolation, alienation, and intense fear. Frequently, horrific secrets can be discovered regarding sexual or physical violence that have become embedded in the poetry of psychotic talk. While factors of presence, love, and compassion may not be enough to help, no philosophical or behavioral technique will succeed without them; and medication remains a form of chemical restraint scientifically indefensible as a “cure.”
David Walker, Ph.D. is a licensed psychologist in Seattle, Washington who’s consulted with the Fourteen Tribes & Bands of the Yakama Indian Nation since 2000. Prior to moving into private practice, he was a core faculty member of the Washington School of Professional Psychology and has served on faculties at Heritage University, Oakland University, and Wayne State University Medical School. He’s also an award winning writer and singer-songwriter. Learn more about his critiques of the mental health system in Indian Country, as well as his novels, poetry, and music at www.tessasdance.com
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
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