Transcript HISTORICAL AND CURRENT TRAUMA: EXAMINING COMMUNITY

HISTORICAL AND CURRENT TRAUMA:
EXAMINING COMMUNITY MEMORIES
FOR THE HEALTH OF A NATION
A Community-Based Participatory Research initiative by the Seneca Nation
and The University of New Mexico – School of Medicine, Center for Native
American Health, & Department of Family & Community Medicine
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Seneca scholar Dr. John C. Mohawk
on colonization:
“…it is the greatest health risk to indigenous
peoples as individuals and communities.
It produces the anomie - the absence of values and sense of
group purpose and identity - that underlies the deadly
automobile accidents triggered by alcohol abuse.
It creates the conditions of inappropriate diet which lead to an
epidemic of degenerative diseases, and the moral anarchy
that leads to child abuse and spousal abuse.
Becoming colonized was the worst thing that could happen
five centuries ago, and being colonized is the worst thing
that can happen now.”
Photo: http://www.hartwick.edu/x23075.xml, viewed 11-25-08.
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The Seneca Study

2 Linked Investigations
 2 Focus groups of Seneca Elders (N=16):
○ What are the traumatic events in our history?
○ How have the events affected our health?
 Mail survey of current users of SN Health Department
services (N=559):
○ Historical Losses & Historical Losses Associated Symptoms
○ Individual health, health-related quality of life, coping
○ Social support – family, friends, significant others
○ Community caring
○ Cultural identity and values
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Participant Characteristics
(Enrolled Seneca Adults)
Focus Groups (N=16)
Survey (N=559)
Gender: 9 females, 7 males
Gender: 67% female
Age Range: 50-90+ years
Average age: 49.5 years
Residence: On-Territory
Marital status: 47% married
Roles & Backgrounds: Elected
tribal official, traditional healer, tribal
health professional, lay health
worker, homemaker, ironworker,
railroad worker, educator, veteran.
Residence: 70% live on Territory
Education: 24% college graduates
Employment status: 19.2%
unemployed/working only part-time
Annual family income:
61.1% < $40,000
Average # People in household:
2.57
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Focus Groups
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A Common Dialogue – 7 Domains of Historical Trauma or
Historical Loss
Pollution
and
Chemicals
Education,
Schools,
Knowledge
Medicine,
Healing,
and
Health
White Man
SENECA
ELDERS
Intergenerational
Relationships
Alcohol
Food
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Traumatic Events identified by Elders
Buffalo Creek Removal; Elected form of government; Thomas Indian School; Kinzua Dam; Land Claims;
All wars; Gas stations; Cigarette sales; Smoke shops; Casinos; Loss of food sources because of
pesticides and chemicals; Packaging of food in cans and plastics; Loss of Seneca language; Removal
to reservations; The Smithsonian National Museum of the
American Indian; 1924 Citizenship Act; Indian prohibition of
alcohol; Tribal politics interferes with relationships; Invaded
by Whites; White educational system; Seneca children in 3
different and competing White school systems; Labeling
Seneca students with attention deficit; Non-Native teacher
orientation about culture; School-based learning of Seneca
language in 15 minutes; School children taught White ways,
leave Seneca ways behind; White influence on Seneca
parent and child relations; Loss of respect for elders by kids; Loss of respect between parent and child;
Health care, too many pills; Western medicine, pushing pills; Traditional healers as health option; Loss
of medicines because of pollution; Disrespect by Western medicine for natural circle of life; People not
sharing Seneca land; No access to natural medicines if on personal property; Loss of family members
because of wars; Seneca names changed to White names; Depression Era; Quaker schools; Bussed
from Red House Indian School to Salamanca school; Pollution of creeks and rivers; Introduction of
alcohol to American Indians; White religions instead of traditional way of life; Parenting changes
because of parents working outside of home; Parenting changes because of single parents; Assault on
Seneca identity; New housing instead of older housing; Location and closeness of new houses;
Railroads through Seneca land; Changes in eating habits; Lower activity level; Bingo; Loss of Seneca
lands due to alcohol use; Loss of active lifestyle.
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Seneca Elder Beliefs About the Association
between Historical Traumatic Events and Health

Seneca male elder (placed in the Thomas Indian School at
age 5):
 “I used to drink in school. I made sure I had a bottle in the
locker. I don’t know why, maybe that got me through the day. I
don’t know.”
 “The memories of it are all right there.”
 “My form of therapy is to talk about it because if you hold it in it brings on
that depression, I’ve been in that.”
 “Some people have so much anger and they don’t understand why they
are so angry.”
 “Nerves, being nervous fits in there too.”

Response from Seneca female elder to above:
 “…the mental is what brings on the physical, inside, like diabetes and
the high blood pressure.”

Additional response from another Seneca female elder:
 “And the end product is your heart, heart problem after all that. If you
want to take it in sequence.”
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Health Survey
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• Depression Symptoms
• Anxiety Symptoms
• PTSD Symptoms
• Tobacco Use
• Alcohol Use
• Illegal Drug Use
• Obesity
• High Blood Pressure
• Heart Disease
• Diabetes
• Asthma
• Arthritis
Physical
Mental
Historical Losses/Historical Losses Associated Symptoms
Spiritual
• Spiritual Importance
• Frequency of Spiritual
Practice
• Sense of Harmony
Emotional
• Coping
• Self-efficacy
• Calm/Peace
• Vitality
• Lonely/hopeless/
worthless
• Reciprocity
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Historical Loss Scale*
% who think of the following losses at least weekly:
Family ties due to boarding schools
15.5
Familes due to gov't relocation
17.3
Land
30.5
Self respect from poor treatment
36.2
Traditional spiritual ways
36.6
Language
42.5
Respect by children for traditional ways
43.5
Trust in whites from broken treaties
44.8
People through early death
46
Culture
47.5
Respect by children/grandchildren for elders
55.5
Effects of alcoholism on our people
60.3
0
N = 543-558.
* Source:
comm psy, 33(3-4):119-130.
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20
30
40
50
60
70
Whitbeck et al. 2004, Conceptualizing and measuring Historical trauma among American Indian people. Amer j of
Historical Loss Associated Symptoms Scale*
% who frequently experience the following feelings/symptoms when
they think of historical losses.
Aviod people/places
Often/Always
Sometimes
Rage
Loss of sleep
Isolates/distant
Loss of concentration
Shame
Anxiety or Nervousness
Discomfort around whites
Fearful or distrust of whites
Feel like its happening again
Sadness or Depression
Anger
0
10
N = 546-557. * Source: Reference listed on previous slide.
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30
40
50
Symptoms of Psychological Distress (%)
70.0
60.0
63.0
50.0
44.9
40.0
30.0
46.5
39.9
30.8
20.0
10.0
0.0
Depression,
≥ 3 of 4
symptoms
Anxiety,
≥ 2 of 3
symptoms
PTSD,
Ever had
traumatic
experience
PTSD,
≥ 3 of 4
symptoms
PTSD,
symptoms >
1 month
N = 559 (Depression), 559 (Anxiety), 539 (PTSD). Depression & Anxiety symptoms in past month.
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Chronic Conditions (%)
L to R: N = 521, 547, 545, 547, 544, 543
60.0
50.0
36.4%
54.9
New York State Prevalence Rates (above each bar)
Source: http://www.health.state.ny.us/statistics/)
26.0%
43.9
40.0
22.9%
37.2
30.0
07.7%
33.1
12.9%
23.5
20.0
07.0%
15.3
10.0
0.0
Obesity
(BMI ≥ 30)
High Arthritis Diabetes Asthma Heart
Blood
Disease
Pressure
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Wisdom-based Knowledge about Historical
Losses: PTSD & Diabetes
Depression
Symptoms (+)
Historical
Losses
Associated
Symptoms (+)
Conduct path analysis to
explore links & develop
interventions.
Historical
Losses due to
Effects of
Alcohol (+)
Community
Vitality &
Caring (-)
PTSD
Symptoms
Age (-)
N = 420; Adj R 2 = .249
Self-Efficacy
(-)
Body Mass
Index (+)
High Blood
Pressure
(+)
Age (+)
PTSD (+)
Diabetes
N = 499; Nagelkerke R2 = .312,
Hosmer & Lemeshow 2 = 5.276, df=8, P=.728
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Seneca Nation
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Practical Implications
Achieving good health for American Indians requires
more than symptom-focused, clinic-based care. It
requires an informed consideration of tribal history, an
awareness of demographic influences and social
determinants, and a complementary system of
wisdom-based knowledge, cultural practices, and
culturally sensitive Western medicine approaches.
 Health is not the sole responsibility of a tribal health
department. In tribal communities the Western notion
of integrated care must be indigenized to include
health-related linkages across ALL programs
(community caring), e.g., every program must
demonstrate how its mission and vision contributes to
the health and well being of the People.

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Policy
Lead & Live by example… Resolution by the
Tribal Council on Nov 15, 2008, as recommended
by President Snyder, to adopt a zero tolerance
drug and alcohol policy imposed upon members of
Tribal Council and Executives.
 SN Health Department reorganization plan to
include requirement for all SNHD personnel to
complete an orientation to SN history and culture.
 Strategic planning by the SNHD in partnership
with all other SN programs to develop an
integrated and health vision and universal health
policy with benchmarks for ongoing evaluation.

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IMPROVING PRACTICES: Strengthening our Sovereignty
Strengthen Knowledge & Dissemination of Seneca History
• Address historical trauma – eliminate influence of colonization under Seneca elders’ guidance.
• Factual Seneca history must be made available to every Seneca, e.g., develop a timeline of
significant events in Seneca history, publish in tribal newsletter.
Strengthen Cultural Health
• Reclaim/restore the Seneca language – it is the cultural foundation of Seneca life.
• Create opportunities to know, practice, & be proud of the Seneca way of life.
Strengthen Community Health
• Create a vision for the health of the Seneca Nation that allows all Senecas to contribute and
that models core cultural values and social caring and vitality.
• Make Seneca health and well-being a living and annually renewable tribal policy.
Strengthen Family Health
• Create opportunities that strengthen families and intergenerational relationships.
• Support heads of households, i.e., physically, emotionally, spiritually, socially, and economically
Strengthen Individual Health
• Recognize and respond to the multi-dimensional nature of health.
• Include the individual as a health partner and expert in Seneca community health promotion
and disease prevention.
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