In this guest post, Dr. Margaret Moss talks about the health of American Indians and how it has been shaped through historical traumas related to US federal policy. Dr Moss is an enrolled member of the Three Affiliated Tribes of North Dakota and an Associate Professor at the Yale School of Nursing.

I first heard about historical trauma, as an explanatory concept, about 10 years ago in my role as an academic.  Without knowing the term, I had seen and experienced it playing out in those I knew or loved; nursed; or partnered in research with; and even in myself during my ‘more than a few’ decades on this earth.  Historical trauma as a concept has been applied to groups such as those surviving the Holocaust and their descendants, as well as to the Japanese who suffered internment camps in the US during World War ll and their descendants.  For American Indians, “historical trauma is defined as cumulative trauma over both the life span and across generations that results from massive cataclysmic events such as the Wounded Knee Massacre.”  In fact, historical trauma has been used to describe an American Indian holocaust by Braveheart and others (1998). The Lakota researcher also defines it as unresolved historical grief across generations.

I have described in previous postings on my own blog how federal policy periods, specifically aimed at American Indians, were carried out that resulted in loss of life, culture, language, place, sovereignty and family structure.  This list of losses is far from comprehensive.  Some of the more detrimental eras were named:  removal (1825-1850); reservation (1850-1887); allotment and assimilation (1887-1934); and termination (1940s-1961).  I maintain that historical trauma ultimately affects health.  As an American Indian nurse, I am fortunate to be able to combine paradigms in that both groups see health as holistic.  Health in the holistic view includes: physical, mental, emotional and spiritual domains of the person.  Much of the early work on historical trauma focused almost solely on non-physical domains, i.e. grief, stress, post-traumatic stress-like symptoms, etc.

The stunning health differences that are seen between American Indians and either Whites or ‘all races’ as reported by the Indian Health Service in ‘Trends in Indian Health’ (2002-3) can be found on their website: www.ihs.gov .  The Indian Health Service is a national health agency under the US Public Health Service charged with the health care of members of the 565 federally recognized tribes.  Some of the differences as noted in their report includes: 1) tuberculosis 533 percent greater; 2) alcoholism 526 percent greater; 3) diabetes mellitus 208 percent greater; 4) unintentional injuries 150 percent greater; 5) homicide 87 percent greater; 6) suicide 60 percent greater; 7) pneumonia and influenza 42 percent greater, and; 8 ) firearm injury 26 percent greater.

One difference noted between Holocaust, other trauma survivors, and American Indians is that for American Indians “[t]here has been no ‘safe place’ to begin again”. In other words, catastrophic group traumas such as the Holocaust, had a beginning and an end.  The survivors and descendants are dealing with the repercussions.  However, for many in Indian Country, historical and contemporaneous group and individual trauma continues.  There has been no end wherein now healing can begin.  That is an important distinction. The investigators found that historicalin the case of American Indians may have to refer to its beginnings in the past as opposed to a distinct historic block of time.

This sustained, persistent trauma- both current (see statistics above on homicide, suicide, injuries and firearms) and historically invoked but persisting today- grief- has most likely impacted the inability to make real strides today in raising the health status of American Indians.  Admittedly this is a quite heterogeneous group with variations in lifespan and disease prevalence.  Some of the numbers look close to those for US numbers broadly.  However, when drilling down to some specific groups one finds huge differences.  For instance, the average life expectancy of a male born today on the Pine Ridge Reservation is in the 40s; diabetes rates can be as high as 10 times that of the White or ‘all races’ rates.  There are explanations beyond genetics and socioeconomic circumstances.  One of these is likely the health manifestation of historical grief and trauma coupled with individual current trauma.  And it is the persistence of the stress and crushing burden that feeds into these numbers.

In my own family, I had three Native brothers and sisters.  Two grew up with me, 1 did not. They have all died with an average age of 40.  Between the families was a variance of socioeconomic standing, economic ‘class’, education and reservation vs. suburban upbringing.  It did not matter in the end.