WESTERN AND INDIGENOUS CONCEPTIONS OF HEALTH AND ILLNESS
Updated: Nov 11, 2019
Through the adoption of a conceptualization that divides sharply between western and non-western frameworks, the merits of perspectives outside of dominant understandings of clinical psychology and psychiatry are likely to become overlooked. Particularly relevant to Canadian practitioners, the interface between western and indigenous conceptions of health and illness incites evaluations of medical conception of explanation and effective treatment along with appropriate delivery in a multi-cultural context.
REDUCTIONISM AND DETERMINISM
One of the challenges of positivist conceptions is its intolerance towards non-positivistic explanation of phenomena. Certainly, clinical treatment is laden with language use and cultural assumptions that may limit its performance generally, and perhaps especially within certain communities. For indigenous patients, contemporary biological reductionism tends to grossly marginalize socio-historical levels of explanation that remain essential to understanding the etiology of mental illness (Marsella 2010).
Due to an absence of socio-historical factors in reductive thinking, its ability to understand complex manifestations of pathology becomes very limited. The recognition of social determinants of health, for example, recognizes the involvement of social conditions when investigating health status, as opposed to primarily exploring individual risk factors. According to the Commission on Social Determinants of Health (2008), health status is not solely a natural phenomenon but must also include social factors, such as historical and existing political arrangements.
For example, indigenous communities often experience low income and poor housing, which correlates with poor mental health. A legacy of socio-cultural trauma is also illustrated in high rates of suicide among descendants of survivors from the residential school system in Canada (Elias, Mignone, Hall, Hong, Hart, & Sareen, 2012). High rates of infant mortality have also been identified as a significant environmental factor for suicide rates among indigenous women in Australia (Tatz, 2001). However, this information is often neglected in favour of illustrating genetic predispositions (143).
CLINICAL POLARIZATION OR PLURALITY
Critiques of reductionist models should not dismiss the utility of western rationality. Certainly, contemporary clinical psychology and psychiatry has been able to offer a vocabulary and methods capable of delivering achievements worthy of confidence. However, western practices may improve its contribution to patients by recognizing the existence of other beneficial approaches.
Theoretical and pragmatic application in clinical settings offer a dilemma for practitioners who wish to be both cautious of cultural sensitivity while also acknowledging the efficacy of diagnosis and appropriate treatment. It seems necessary that cross-cultural competency requires the effective integration of both contemporary and indigenous knowledge in order to provide best practices.
As social organisms, interactions and interpretations encompasses multiple dimensions of intra- and interpersonal experiences. This multi-layered conceptualization of the self can be pictorially represented in the pan-indigenous medicine wheel. With the individual self placed at the centre of a circle, a series of concentric circles emphasizes one’s sense of place and direction within not only themselves but the community more generally. Preliminary evidence has suggested that these principles have been compatible with certain western psycho-social interventions, namely cognitive behavioural therapy (Morsette, Swaney, Stolle, Schuldberg, van den Pol, & Young, 2009; Bigfoot & Schmidt, 2010; Nowrouzi, Manassis, Jones, Bobinski, & Mushquash, 2015).
Collaborative practices may not necessarily involve a complete syncretism of ideas. However, the use and application of etiological theories in clinical psychology and psychiatry seems unlikely to be successful among indigenous communities if an ecological paradigm remains absent. Ideally, a maturation of practice is likely to simultaneously embrace the polarization and plurality of both perspectives in such a way that avoids over-identification with either. It is reasonably expected that the recognition of commonalities between western and indigenous knowledge should encourages collaborative dialogue. However, does a distinction between appreciation of tradition and the appropriation of knowledge become a risk?
Bigfoot, D. S. & Schmidt, S. R. (2010). Honoring children, mending the circle: Cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska Native children. Journal of Clinical Psychology. 66(8): 847-856.
Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Retrieved from:
Elias B, Mignone, J., Hall, M., Hong, S.P., Hart, L., & Sareen, J. (2012). Trauma and suicide behaviour histories among a Canadian indigenous population: An empirical exploration of the potential role of Canada’s residential school system. Social Science and Medicine. 74(10): 1560–1569.
Marsella, A. J. (2010). Ethnocultural aspects of PTSD. An overview of concepts, issues, and treatments. Traumatology, 16(4): 17-26.
Morsette, A., Swaney, G., Stolle, D., Schuldberg, D., van den Pol, R., & Young, M. J. (2009). Cognitive behavioral intervention for trauma in schools (CBITS): School-based treatment on a rural American Indian reservation. Journal of Behavior Therapy and Experimental Psychiatry. 40(1): 169-178.
Nowrouzi, B., Manassis, K., Jones, E., Bobinski, T., & Mushquash, C. J. (2015). Translating anxiety-focused CBT for youth in a First Nations context in Northwestern Ontario. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 24(1): 33–40.
Tatz, C. (2001). Aboriginal suicide is different: A portrait of life and self-destruction. Canberra, Australia: Aboriginal Studies Press.