Native American Mental Health, Alcoholism, and Access to Care

Introduction

One of the most disturbing aspects of life as a Native American is the fact that this population suffers from historical trauma — the trauma of having lost their land, their way of life, and essentially their freedom to self-determination when the American colonies began to assert themselves and push Native peoples off their land. The Cherokee were expelled from the East by the Indian Removal Act in the 19th century, and countless more were slaughtered in brutal territorial wars of conquest as the US expanded westward. Historical trauma is a real struggle for this invisible minority (Brown-Rice). It has led to a deterioration of mental health among Native Americans, who now suffer from alcoholism, substance abuse, and a lack of access to adequate mental health care (Hartmann and Gone).

Compared to other ethnicities and racial groups, Native Americans experience higher lifetime substance abuse rates. There are many factors that contribute to this statistic: historical trauma, violence, unemployment, and low levels of educational attainment. At the end of the day, it is evident that Native Americans have been marginalized for centuries — and such marginalization denies them equal opportunity and boxes them into a way of life that is psychologically dehumanizing ("Substance Abuse Statistics for Native Americans"). Famous Native American novelist Sherman Alexie writes about what it is like to be an alcoholic Native American in his novel Flight. He also describes what it is like to be, essentially, an orphan — which is what many indigenous people feel themselves to be in white America, where Uncle Sam is the symbol of patriotism. There is literally no representation of Native American greatness in the mainstream consciousness. It should not be surprising, therefore, to find that this invisible population suffers from alcoholism and poor mental health more than any other population.

Before analyzing the alcoholism and mental health of the Native American population, it is helpful to understand this population from a humanistic point of view. Few authors have penetrated the Native American psyche like Sherman Alexie — and as a Native American himself, his perspective is vital for understanding what it is like to belong to this community. In Flight, Alexie describes the life of a Native American boy who has lost his mother to cancer and whose father is lost in a haze of alcoholism. The boy bounces from one foster home to another, and nearly all the Native American men he encounters are abusive, violent drunks. There is a self-destructive impulse that runs through these characters, as though they are continually throwing themselves upon their own spears in despair at having lost their way of life two centuries ago.

Understanding the Native American Experience

There is also the fact of racism, and Alexie describes it in bitter detail in The Absolutely True Diary of a Part-Time Indian: "Our white dentist believed that Indians only felt half as much pain as white people did, so he only gave us half the Novocain" (2). It is an offhand remark delivered with dark humor, but it cuts to the heart of the matter for Native Americans. They have been mistreated as a population, and that pain is real. It is part of their historical trauma and part of the reason so many of them seek to self-medicate. It is also why so many of them need mental health services. Yet the issue remains: they are a marginalized population, and access to adequate mental health care is not available to them. Because no one is there to treat them, they treat themselves — with alcohol — which only makes matters worse.

Native Americans carry a great deal of baggage in terms of historical trauma, and that baggage has never been dealt with in a meaningful manner. Alexie's novels explore the underlying reality of this most invisible population. Yet Alexie is an author who is frequently marginalized and even banned in some parts of the US. He is seen as provocative and unfit for school curricula because he raises matters that some consider offensive — without understanding that Alexie is merely reflecting the truth of the situation. If the truth of what the Native American population has endured for centuries is not confronted, their situation will never improve. Mainstream America drove them out of view and now still refuses to give them adequate consideration.

Alcoholism is a significant contributor to mental health problems such as depression and suicide. Native Americans are highly susceptible to these problems. As the Centers for Disease Control and Prevention note, death records show that American Indian and Alaska Native (AI/AN) death rates for both men and women combined were nearly 50 percent greater than rates among non-Hispanic whites during 1999–2009. The fact that suicide rates are 50% higher among Native Americans than among whites reveals how deeply troubled this invisible population is: they have no sense of inclusion, no sense of hope, no sense of belonging, and no sense of having a future. They are burdened by mental health problems that drag them down, and their constant crutch — as Alexie illustrates again and again — is alcohol, which has afflicted Native communities since it was first introduced by white settlers.

Alcoholism and Its Consequences

The culture of Native Americans is built on a sense of strong interconnectedness: all of life is meant to be interrelated and interdependent. When their lived experience suggests otherwise — when it shows them they are cut off and cast aside rather than connected — it causes them to feel as though their entire world is collapsing. That is the psychosocial basis for their dependency on alcohol (Tachine, Cabrera, and Yellow Bird). When family systems break down, they seek escape in alcohol. When social support systems fall apart, they again turn to alcohol. And when years of abuse drive them into a state of mental deterioration, there is no helping hand to pull them out of the pit.

Their alcoholism keeps them mired in an economic pit as well. Native Americans have the highest poverty rate in the US. Fewer than one in five Native Americans will ever obtain a college degree, which severely limits their job prospects and prevents upward mobility. The cycle of hopelessness continues from one generation to the next (Krogstad).

Conclusion

The Native American population is an invisible population that has been marginalized by mainstream American society for centuries. It should therefore not be surprising to find that this population — to whom interconnectedness means so much — suffers so greatly from mental health issues such as depression, suicide, and alcoholism. Their family structures have deteriorated, they live in poverty more than almost any other group in the US, and there is little to no access to mental health care for this community. This is a group in need of help — but help is slow to come because there is so little understanding in mainstream America of what it means to be a Native American in today's world.