Strengthening Aging and Gerontology Education for Social Work SAGE-SW

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

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Origin of Illness Across Cultures

• Prior to beginning PowerPoint have students
  engage in the Origins of Illness In Class
  Activity

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Traditional Concept of Wellness1

Holistic
Medicine Wheel
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
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Medicine Wheel Concept of Health Remains
Significant2

• 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 patients symptoms and enrich their
  quality of life.
• - Louis T. Montour, MD, CM CCFP ABFP Presented
  at the Fifth Annual Meeting of the Native
  Physician Association in Canada, Ottawa, Ontario,
  August 23-25, 1996.

Big Horn Medicine Wheel Wyoming
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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)

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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/wh
eel.html
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Traditional Stories of Illness

Origins of Disease and Medicine A Cherokee
example

• 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.

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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

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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

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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.

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Social Work Implications

• Listen to persons 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?

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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?

TO STUDENTS How would you adapt the Explanatory
Model questions for a Native American elder?
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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?
  sectionculturecultureliteraturecatPdWeE5zX1DE
  
• 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