Culture as Treatment, Culture as Inoculation

Matthew Kelley Ph.D.

       In an attempt to design more effective treatment protocols for Dine’ people, several anthropologists suggested that such programs must utilize traditional Navajo cultural techniques, traditional settings, and traditional self-empowerment programs (French, 1989; Grobsmith & Dam, 1990; Kavlahan, 1985; Westermeyer & Canino, 1994). A growing number of medical and psychosocial service professionals also insist that Native American cultural values and practices are essential when assisting traditionally-oriented Native Americans ((Brady, 1995; Garrett & Garrett, 1994) (Mail & Wright, 1989) (Mitchell & Patch, 1986, May; Rankin & Kappy, 1993; Terrell, 1993; Young, 1986).  Jilek (1994) also presented a strong case that most community-recognized traditional medicine practitioners are “potentially useful to modern health care schemes as an inexpensive therapeutic resource,” especially in important and crippling psychosomatic and psychosocial issues (Jilek, 1994) (p. 219).  He believed that effective intervention must always be relevant to the sociocultural context from within which the substance abuse occurs.  He also stated that “cultural-congenial practices of indigenous traditional healers” are often the most relevant psychotherapy. 

      As support for his beliefs, Jilek cited a Buddhist healing center for addicts in Laos which informally credited themselves with a 70% success rate, a Malay Islamic center with a well documented complete abstinence rate of 8-35% (depending on the healer), a traditional Japanese center who published a 6 month 53% abstinent rate, a Arab Islamic center showing significant improvement over the government’s medical- model based center, and a group of young problem drinkers from the North American coastal Salish tribe who had a long-term abstinence rate of over 50% after being initiated  into their traditional dance society.  As an illustration of the importance of spiritual values in treatment, Jilek also mentioned one Saudi hospital study which stated that 75% of their clients who were motivated by inner religious values were able to maintain abstinence for at least two years. This compared to only 33% of the participants who were also strongly motivated, but who were motivated by other non-religious considerations. 

       Jilek (1994) sees these important therapeutic values in many Native American therapeutic /spiritual practices (e.g., sweat lodge, Sun Dancing, social and personal ceremonies, winter spirit dancing, the Native American Church, and other methods of spontaneous induction into enhanced-altered states of consciousness). When properly done within the right context, such complex techniques are often applied more with groups than with individuals. They also generally involve the sacred use of culturally validated symbolic acts, words, and objects; the client’s public admission and promise of a behavioral correction; and specific internal and external purification (herbs or action). An enhanced altered state of consciousness is also often involved.  Jilek describes this beneficial state as  “ a culture-congenial situation that facilitates psychodramatic abreaction and affective release may be achieved through catharsis triggered by adequate sensory stimulation, or in an altered state of consciousness induced by psychological, physiological, or phytochemical means” (p.247).  He went on to say that the therapeutic effects of local healing practices are also usually magnified by the empathy and support shown by kinspeople and community members.

       When comparing accepted western methods with such indigenous therapies, Jilek believed that (within a proper context) indigenous procedures often have the following advantages: (a) there is absolute cultural-congeniality between client and practitioner (unlike many western relationships which occur between doctor and patient); (b) the personality, “power,” and rapport of the healer is emphasized more than the mechanical technique (a point often downplayed in both medicine and formal psychotherapy); (c) such therapies are always very holistic integrating psychology, physiology, social, and spiritual components (unlike the trend towards specialization and fragmentation in many western techniques); (d)  traditional healers are generally very accessible, available, and permanent (urban health clinics tend to be difficult to enter and are always changing); (e) enhanced-altered states, engaged emotional conditions, and sharply focused awareness are often utilized in conjunction with culturally validated images (in contrast to the general western insistence that change occurs through intellectual insight and education); (f)  therapies usually involve the re-integration of family, kinspeople, and community (unlike the often isolated western clinics which mainly work on individuals outside of their personal context); (g) indigenous therapies tend to be most cost-effective due to their lower overhead and group orientation. Indigenous practitioners may also act as community role models (very unlike the usual aloofness and isolation of western health care providers).

       In a further comparison between the two styles of therapies, even the basic intensity level of Native American therapies is often even severe when compared to standard western practices. Most of the favorite Dine’ practices, for example, involved hours and some times days of therapy. A family sponsored health promoting Yebache’ dance lasts seven days and nights. The Sun Dance lasts four days and nights. Sweatlodge practices last from two to four hours. Even the daily talking circles in HBS rarely take less than two hours. Many of these practices involve the extremes of emotion such as fatigue, fear, pain, hunger, nervousness, ecstasy, altered states of consciousness, laugher, boredom, heat, cold, and heightened expectation. Several days at a Sun Dance or a few hours in the sweatlodge will cause almost  any psychotherapist to re-analysis the commonly accepted intelligence of trying to significantly affect behavior change during a 55 minute-hour (and in an air conditioned room from across a desk).  

       Cultural practices are not, of course a panacea. They do have obvious limits and disadvantages. As in western practices, harm and mistreatment can occasionally occur. Most indigenous people, however, (who have access to western-oriented medicines) manage to balance (compliment) the mechanical emphasis of the western approach with the psycho/social/spiritual emphasis of their own practitioners. Jilek did maintain, however, especially in the field of substance abuse where western efficacy is constantly challenged, and where the downside of abuse is so immediately terrible, that even the most drastic indigenous intervention is usually worth the risk (“intelligent-risk” of course). 

       Brady (1995)  also issued some caution when simplistically and automatically considering “culture as treatment.”  Unlike the popularized version of persistent and static stereotyping presented by many anthropologists, culture in any society is always dynamic, variable, and ever changing. Culture is not the “past” or a static “thing” (an external ‘agent’ that can do things by itself). Because culture is ever evolving and adaptive, current cultural values in themselves may actually contain personally destructive values.

     As an example, Brady pointed out that several of the most traditionally-oriented and remote Australian tribes have adopted petrol sniffing into their cultural behavior as a ‘leveling’, solidarity-building, and cultural resistance against becoming too much ‘whitefella’. In another example, the culture of some American college fraternities is sometimes alcohol-based. Brady also mentioned that some Native American groups are so connected to alcohol (or drugs) that to not drink is to not be socially accepted as a member. In some of these cases, excessive drinking has actually become a way to resist the dominant society and to proclaim both ‘tribalness’ and apparent indifference to the ‘outside’ world. For example, one well published religious leader and political advocate for Lakota cultural values is a heavy binge drinker (personal observation). Although this behavior is not respected by most traditional healers and people outside of that particular society, this medicine man (accepted by his local following) justifies his drinking as an expression of solidarity, rebellion, passion, healing his heart, and power.

     In other cases where tradition might appear counter productive to healthier Nations, cultural respect for non-intervention into an individual’s affairs, values against expressing emotion, and anti-authoritarian behaviors can make prevention and treatment programs difficult. Traditions of ‘witchcraft blame’, Christian-like external negative forces (demonic) overpowering individuals, and even the traditional AA concept of powerlessness over alcohol often distracts from the responsibility of both the individual and society. In cases such as these, Brady recommended that both the strengths and weaknesses of indigenous culture must be assessed and that modification (or avoidance) of certain traditional values may sometimes be necessary. She stated that cultural and spiritual values in themselves are relatively ineffective unless they involve local peer groups or are part of a compelling social message.

    [Witchcraft trauma is reported by 41% of the Dine’ men and 63% of the Dine’ women chronic problem drinkers at NCI. Although this experience has deep cultural roots it may best be understood by the non-Dine’ as a cultural perspective similar to the Christian experience of demonic forces (or the devil), or even some of the “new-age” concepts of “bad karma”. The externalization of blame often helps people who feel helpless and overwhelmed to better cope with unconscious forces, unfair events, and incomprehensible behavior.  Although negative “witches” are thought to be more of a concept than a reality by specialists in the Dine’ area, people do get so tired, bitter, and frustrated that they may even claim to “witch” others. Although this phenomenon is well expressed in the Dine’ culture, it also occurs in sectors of today’s dominant culture (not to mention the extensive punishment for innocent “witches in historical New England). NCI traditional counselors generally take such reports seriously and intervene with both protective and empowering therapies.] 

       It is also important to note that a treatment protocol which emphases positive cultural values is almost never intended to return participants to the lifestyles of the past (hunting and horseback).  On the contrary, such practices intended to project a society’s best enriching and empowering values forward into a materialistically modern and dynamic future.  

       Jilek (1994) also commented that rigorous scientific investigation of traditional therapies is often thwarted due to the sacredness of such activities, the personal tendency of the practitioners to guard the details of these activities, the historical experience of religious and medical persecution from outsiders, the invasive nature of most “scientific” methods, and the confusing but necessarily multi-variable nature of these activities.  Rigorous outcome studies, he stated, are also limited by the lack of reliable records, the logistical challenges of rural life, the problem of finding the post-treatment participants, the legitimate caution shown towards authorities, and the problem of verification. The lack of reliable outcome studies among the often highly mobile Native American population was also expressed by Grobsmith and Dam (1990). Although Jileck admitted the lack of well controlled data to fully substantiate his views, he also stated that the collection of broad evidence on many different continents and in many different contexts illustrate that many indigenous therapies are generally as, if not more, successful than what we’ve come to know as the “Minnesota” or “western psychosocial medical model of prevention and treatment.

       At the very minimum, Jilek suggested that the health care providers of minority populations should always identify the indigenous culture-specific concepts of both care and disease, the attitudes towards substance usage and abuse, and the views regarding prevention and treatment. He also encouraged active collaboration between western and indigenous health care providers.  He strongly stated that his request is a professional obligation which is legally and ethically required (after the United States repeatedly signed the World Health Organization’s declaration on primary health care; originating in Alma Ata in 1978) (Organization, 1978). 

       Caution, however, must again be noted that a single treatment protocol for all participants (even within one culture) is likely to be ineffective.

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