Exploring a Stress-Coping Model For Healing Spirit Wounds

Generational trauma refers to trauma that can be passed from one generation to the next and is sometimes referred to as a ​soul wound​ by American Indian and Alaska Native populations. Generational trauma is linked to negative health outcomes such as morbidity; HIV risk; alcohol and drug use and abuse; and mental health disorders such as anxiety, depression, and PTSD. ​Within this context, one may conceptualize substance use as a symptom rather than the root issue. As denoted by the name, soul wounds are of a spiritual nature rather than physical. As such, one can reasonably conceive that the cure must fit the cause; thus the medicine must also be for the spirit. 

Current stress-coping models and evidence based therapies (EBTs) often fail to fully address cultural needs, as they often do not take into account generational trauma and cultural values, instead approaching healing from a Eurocentric perspective.​ Doing so may cause greater harm than good, as it runs the risk of re-enacting colonialism in a clinical setting ​. In order to avoid imposing Eurocentric values within substance abuse treatment for Alaska Native populations, providers may benefit from utilizing an Indiginest Stress-coping model and culturally informed interventions tasked for spiritual healing, such as Drum-Assisted Recovery Therapy for Native Americans (DARTNA).

As indigenous people, American Indians and Alaska Natives (AI/AN) were the first inhabitants of North America. Yet, according to the 2010 United States census these groups now comprise just 1.7% of the United States population. This statistic includes people who identify as American Indian or Alaska Native and at least one other race.​ Of this 1.7%, Alaska Natives account for approximately 5% of the total population.​ This statistic is not shared to trivialize their history or role within the nation, but rather as a starting point to begin to explore their stories, including the marginalization and trauma these groups experienced at the hand of colonialism and its far reaching effects into the present day.

Alaska Native culture is comprised of 11 distinct cultures, speaking 20 different languages, which can be organized into five different regional groups: Athabascan; Yup’ik and Cup’ik; Unangax and Alutiiq; Inupiaq and St. Lawrence Island Yup’ik; and Eyak, Haida, Tsimshian, and Tlingit. While there may be similarities between groups, it is important to not make sweeping generalizations about all tribes and subcultures, known as cultural glossing​, as there are important differences in language, culture, and customs. However, for the scope of this paper, we will not be able to explore each cultural group individually. We will instead focus on the similarities of experience within a broader context of historical trauma.

Conceptual Framework for Alaska Native Spiritual Healing

Napoleon and Madsen provide one conceptual framework for Alaska Native spiritual healing. However, it is not the only perspective. It should be noted that Napoleon comes from a Yup’ik background and this informs his cultural values and views. Napoleon conceptualizes the village as a circle. When the village is healthy, the inhabitants are safe within the circle. This is a gift from the Creator to his people. Values and attributes such as love, understanding, culture, kindness, history, goals, and truth both protect and strengthen the village and its people. However, for many Alaska Natives, the circle has been broken by the trauma of ​The Great Death​, a term used to describe the massive physical and spiritual death experienced from epidemics brought by European colonists and the resulting loss of culture. In order for healing to occur, the circle must be made whole by those who live within it. The circle is the spirit of the village and must be repaired by spiritual means: employing the help of the Creator and the people coming together in truth, love, patience, understanding and forgiveness.

Indiginest-Stress Coping Model

Furthermore, there is a need to shift our conceptualization of stress-coping models. Similar to EBTs, current stress-coping models tend to reflect Eurocentric perspectives and values and do not emphasize the needs and strengths of Alaska Native cultures. The Indiginest-Stress Coping Model adapted by Walters, Simoni, and Evans-Campbell looks at the relationship between stress and trauma on health outcomes, as moderated by factors that can function as coping buffers. Although the relationship between stress, protective factors, and health outcomes is not new, the model is unique in that it looks at ​culture-specific​ risk and protective factors.

Examples of culture-specific trauma may include historical trauma, violent crimes and assault, child abuse and neglect, discriminatoin, and unresolved grief and mourning​. Likewise, cultural protective factors for AI/AN populations may focus on family and community, spiritual coping, traditional health practices, identity attitudes, and enculturation. Similar to Napoleon’s conceptualization of the village as a circle, on may also conceptualize the layers of risk and protective factors as concentric circles. At the individual level factors include biological processes, psychiatric risk, demographic factors, trauma exposure, cognitive behavioral processes and cultural identity. However, we must consider the individual within a larger context of their social networks--their families, communities, and within the broader context--historically with their ancestors​. ​Substance use is associated with colonized status and environmental, institutional and interpersonal sources of discrimination and stress. Additionally, barriers to care and avoidance of care, due to mistrust, can impact substance use rates and negative health outcomes.

Napoleon, references how ​nallunguaq ​is a Yup’ik coping method meaning “ to act as if it didn’t happen.” This was common after the Great Death and Napoleon says that young people are still encouraged by elders to ​nallunguarluku, ​“to pretend it didn’t happen.” Napoleon discusses post traumatic stress disorder and his belief that trying to suppress a traumatic event without treatment will drive it deeper into the soul and cause it to fester there as illness. However, not all who experience trauma will develop PTSD. This is where the importance of positive cultural buffers comes into play.

DARTNA Therapy

Drum-Assisted Recovery Therapy for Native Americans (DARTNA) is a substance abuse treatment model currently being explored which utilized drumming as a core component, along with the inclusion of the Medicine Wheel and the 12 Steps program by White Bison, Inc.

Core Components of DARTNA

The core components of DARTNA are drumming education, drumming activities, gender roles, The Medicine Wheel and the 12 Steps education, and linkages to drumming within the community. Within drumming education includes education regarding the sacredness of drumming. As such, DARTNA beings with a focus on the spiritual dimension, to connect participants with drumming as a spirit medicine and align their recovery process within a Higher Power.

Participant Feedback

Likewise, participants in the DARTNA test program reported a positive experience. Participants reported that the program allowed to reconnect back to their culture, remembering that they are part of something greater. Quotes gathered from participants include: “Yes, that was a reconnection for me back into my cultural place, where I need to be. I had no idea I was part of that medicine, so now I do realize that I’m part of that medicine…” ​ and “…it was reconnecting with my people, my ancestors, my Creator, the people that were around...I didn’t feel by myself no more. I felt a part of it.” ​Participants also reported powerful benefits from their opportunity to participate in drum making, stating that it “woke them up” to who they are. ​ One suggestion that participants provided for improvement related to wanting to honor local Californian tribes, as the test group took place in California. Participants asked if someone could come in with the medicine of California Indians. This is consistent with Native tradition and values--to honor the people of whose land they are on.

Conclusion

In closing, providing effective treatment informed by cultural, traditional, and spiritual beliefs comes with unique challenges and rewards. First, there must be a shift in how we conceptualize substance use, healing, and stress-coping models to be culturally responsive, as current models fail to address substance use as a symptom of spiritual wounds and risk imposing Eurocentric beliefs and values that are incongruent with Native values. Furthermore, while interest in culturally-based treatments is growing, there are still limited opportunities to receive these treatments within clinical settings. Providers may often lack the institutional support to implement programs or may run into barriers during implementation, such as lacking cultural facilitators, tribal liaisons, and Native staff. Additionally, there is the challenge of how to address disagreements about what is traditional. It appears that programs may benefit from having a general foundational base, while providing a level of flexibility for adaptation to specific tribe customs.

If these challenges can be properly addressed, the rewards are great. Well-designed and executed culturally informed interventions provide the space for people to come together in healing. Again, as Napoleon notes, the circle must be made whole by those who live within it. Culturally-informed interventions must be informed and implemented ​by​ the Native people and seek to respect the spirit of the people and their wisdom to heal themselves--only with this perspective can clinical settings begin to provide the necessary medicine for spirit wounds, in hopes to restore the circles that have been broken.