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Moving from Colonization

toward Balance and Harmony:

A Native American Perspective on Wellness
David R. Hodge, Gordon E. Limb, and Terry L. Cross

At best, mainstream mental health services are often ineffective with Native American clients,
and, at worst, they are a vehicle for Western colonization. As such, the authors explore the
notion of abandoning the Western therapeutic project and rebuilding the helping process on
the basis of indigenous knowledge foundations.To this end, they discuss a Native perspective
on wellness that emphasizes balance among the interconnected areas of spirit, body, mind,
and context or environment. From this perspective, mental health is a product of balance
and harmony among these four areas.The authors conclude with a discussion of the practice
implications of this relationally based perspective in which practitioners target interventions
toward improving balance and harmony.

Key words: American Indians; cultural competency;

Native Americans; practice perspectives; spirituality

C urrent mental health practices appear to

be largely ineffective in terms of meeting
the needs of many Native Americans (Gra-
ham, 2002; Weaver, 2004). According to nationally
representative survey data (N = 134,875), Native
solution, according to this view, is to increase access
to professional service providers so that mental health
challenges can be met.
This hypothesis, however, is based on the premise
that Native Americans lack sufficient access to pro-
Americans are significantly more likely to indicate fessional service providers.Yet according to recent,
that they have unmet needs in the area of mental nationally representative data, Native Americans
health care than are white Americans (Harris, Ed- are just as likely as whites Americans to use mental
lund, & Larson, 2005). Conversely, the perceptions health services (Harris et al., 2005). This is true for
of unmet mental health care needs among African those experiencing one or more health symptoms
Americans, Asians, and Hispanics are usually lower as well as for those with serious mental illness. For
than those of white Americans—often significantly instance, among Native Americans with serious
lower (Harris et al., 2005).The high level of unmet mental illness (n = 161), roughly 61 percent had
needs among Native Americans calls for some type used mental health services (Harris et al., 2005).
of explanation. In absolute terms, this was the highest percentage
In what might be considered the conventional of service usage among the groups surveyed.These
hypothesis, the higher perceived need among Na- data suggest that the high level of perceived unmet
tive Americans is related to the existence of higher mental health needs cannot be attributed solely to
rates of mental health challenges in this population. lack of access to mental health services.
Indeed, a substantial body of research indicates that An alternative, critical viewpoint posits that the
the prevalence rate of mental health challenges problem lies not with the degree of access but with
among Native Americans is significantly higher the services themselves. Professional mental health
than it is among white Americans and many other services are often perceived by Native Americans
populations (Beals et al., 2005; Harris et al., 2005; to be ineffective (Graham, 2002; Weaver, 2004).
Kulis, Napoli, & Marsiglia, 2002; Stiffman et al., One recent survey of tribal members living on four
2006; Weaver, 2004). Thus, perceptions of unmet reservations (N = 965) assessed the effectiveness of
need are posited to exist because of the magnitude various types of services commonly used to address
of the challenges and the scarcity of resources. The mental health and substance abuse problems (Walls,

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Johnson,Whitbeck, & Hoyt, 2006). Of the 21 types among many Native Americans. Before delineating
of services assessed, those provided by professional this perspective, we discuss how mainstream mental
service providers were perceived to be the least ef- health services can oppress Native clients, in spite of
fective. Services provided by off-reservation social good intentions on the part of practitioners.
workers, the most numerous providers of mental
health services in the United States, were perceived Therapy as Colonization
to be the least effective of all. In practice settings, it is widely accepted that
In short, perhaps the reason so many Native the theoretical perspective brought to the table
Americans report unmet mental health needs— influences how problems are conceptualized and
despite receiving relatively high levels of mental addressed (Tjeltveit, 1999). Practitioners using a
health services—is simply because the provided cognitive perspective may be more likely to view
services do not meet their needs.The service models problems as stemming from unhealthy schemas and
are simply ineffective.Yet, as implied earlier, much of recommend interventions that emphasize salutary
the existing scholarship on Native Americans sup- thoughts. Alternatively, those operating from a be-
ports, either implicitly or explicitly, existing Western havioral theoretical framework may be inclined to
models of service delivery. believe that altering patterns of behavior is the best
This article provides an alternative viewpoint, way to help clients ameliorate problems.
positing that the Western therapeutic project is in- Although it is commonly accepted that values
consistent with many Native American cultures and inform direct practice, less thought is typically
often serves as a form of Western colonization. We given to the values that animate the larger,Western
suggest abandoning this value-informed project and therapeutic project (Coates, Gray, & Hetherington,
rebuilding the helping process on tribal knowledge 2006). Debate exists about the efficiency of various
foundations. In keeping with this goal, we offer a therapeutic modalities (Chambless & Ollendick,
relationally based Native perspective in which well- 2001; Hepworth, Rooney, Rooney, Strom-Gottfried,
ness results from the complex interplay of spirituality, & Larsen, 2006), but the effectiveness of the larger
physical status, cognitive and emotional processes, therapeutic enterprise is typically assumed.Therapy
and environment. Before proceeding, however, the is viewed as the appropriate means to address mental
diversity of perspectives that exists among Native health needs across cultures and populations. Put dif-
Americans should be noted. ferently, psychotherapy is implicitly understood to be
a neutral, scientifically based vehicle through which
Native American—A Constructed mental health problems are best ameliorated.
Concept All human constructions, however, are informed
It is important to recognize that terms such as “Na- by certain sets of values. The therapeutic project is
tive American” and “American Indian” are linguistic informed by and reflects the values of the Western
devices designed to denote contemporary descen- Enlightenment worldview from which it emanated
dents of a wide variety of tribal nations. Over 550 (Cross, 1997, 1998; Gray, 2008; Jafari, 1993; Red
American Indian tribes are currently recognized Horse, 1997;Voss, Douville, & Little Soldier, 1999).
by the federal government (Fuller-Thomson & It is important to note that not all westerners ac-
Minkler, 2005). In addition, many other tribes are cept the premises of the Enlightenment, which
recognized only by state governments, and still have come under considerable criticism from some
others are working to obtain official governmental members of the dominant secular culture (Lyotard,
recognition. Each tribe, whether recognized or 1979/1984). Nevertheless, Enlightenment values
not, is informed by a culturally unique worldview continue to guide the trajectory of the therapeutic
(Trujillo, 2000; Whitbeck, 2006). project.
Although Native Americans commonly affirm a To be clear, we are not talking about individual
number of values (Cross, 1997; Jackson & Turner, practice modalities but therapy as a larger enterprise.
2004), no single Native perspective exists among the This project entails numerous assumptions about
4.3 million people who self-identify as American the nature of reality. Included among these are the
Indian or Alaskan Native in the United States (U.S. assumption that “good mental health” is an end
Census Bureau, 2000). In this article, we present worth pursuing; various assumptions about what
one Native perspective that has broad resonance constitutes both good mental health and dysfunction;

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and assumptions that the discussion and exploration To be clear, adapting therapy with multicultural
of problems benefits those who suffer, problems techniques—for example, matching clients on the
can be isolated and interventions targeted to the basis of gender, factoring in level of acculturation,
localized problem, outcomes in a specific area can or tailoring communication style to match that of
be monitored and measured, and secular licensed the client—in and of itself, does little to mitigate the
professionals are best suited to guide people through colonization (Gone, 2004). Such techniques func-
the healing process. tion to repackage the counseling project in more
Because some degree of consensus exists regarding palatable dress while leaving its central colonizing
these assumptions among mental health profession- function intact. The fact must be faced that profes-
als, the underlying values are rarely questioned. To sional therapy is a thoroughly enculturated project.
service providers who have been socialized to accept As such, it is time to consider revaluating or even
them, the prevailing norms seem correct, true, and abandoning this project and rebuilding the helping
appropriate. Although it is recognized that various process on an indigenous knowledge foundation
therapeutic modalities shape practitioners’ under- (Walls et al., 2006). We discuss the parameters of
standings, the values that inform the larger profes- such a Native perspective on helping in the fol-
sional framework are unconsciously accepted. After lowing section.
years of professional training, the professional mental Before proceeding, it is important to note that
health paradigm is implicitly assumed to reflect the space constraints preclude discussion of all of the
world as it is rather than one particular understand- issues raised in the foregoing discussion. Take, for
ing of reality (Gone, 2004; Kuhn, 1970). instance, the issue of what constitutes good men-
The suppositions that inform many Native tal health. Characteristics viewed as markers of
worldviews differ from the Enlightenment world- psychopathology in the dominant secular culture
view that serves as the foundation on which the may be understood as indicators of well-being in
Western counseling project is constructed (Frame, many Native American settings (Cross, 2001). For
2003; Miller, 2003;Trujillo, 2000). At a foundational, example, communicating with the Creator or other
suppositional level, a clash in values exists in many metaphysical dimensions of the spiritual world can
areas. Native understandings of wellness are typically signify health and well-being in many Native tribes.
not entertained as legitimate options within the Conversely, in the context of the dominant culture,
Western therapeutic project. The array of options such events are often construed as indicators of
presented to Native clients fails to resonate with psychopathology, with hearing a voice external to
them because such options tend to fall outside the one’s self commonly understood to be a marker of
parameters of Native worldviews. Consequently, schizophrenia (American Psychiatric Association,
many Native clients experience therapy as oppressive, 2000).
because their worldviews are effectively marginalized Although we acknowledge the importance of
by mainstream mental health theory and practice such issues, we limit the present discussion to a Na-
(Coates et al., 2006). tive perspective on wellness, drawn primarily from
Native clients are subtly encouraged to adopt a the work of Cross (1997, 1998, 2001), supplemented
culturally foreign worldview through their engage- by those influenced by his work (Coates et al., 2006;
ment in the counseling process (Gone, 2004). In Graham, 2002; Limb & Hodge, 2008) and other Na-
essence, therapy functions as an agent of coloniza- tive American scholars. Central to this relationally
tion (Coates et al., 2006). The only options on the based perspective are the interrelated concepts of
table, the only options deemed legitimate within spirit, body, mind, and context.
the therapeutic project, are foreign ones. Because
practitioners sincerely believe in the worth of the A Native Model of Wellness
larger project, they encourage Native clients to Spirit, Body, Mind and Context
engage the options sanctioned by the therapeutic In the Native model, in contrast to the dominant
project. Thus, despite good intentions on the part secular culture, spirituality is perceived to be central
of practitioners, culturally different Native clients to wellness (Gilgun, 2002; Lowery, 1998). At the core
are subtly coerced into adopting norms derived of one’s existence is the spiritual (see Figure 1). We
from a Western, Enlightenment worldview (Yellow are not so much humans on a spiritual journey as
Bird, 2004). spirits on a human journey—a journey in which

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Figure 1: Native Model of Wellness






(Cognitive & emotional processes)


our spirits will continue to exist in the hereafter mental health professionals (Graham, 2002). In addi-
(Cross, 2001). tion to purely cognitive components like memory,
In addition to the human spirit, spirituality also it also includes intellect, judgment, experience, and
includes transcendent dimensions (Gesino, 2001; affect (Cross, 1997). As such, the concept includes
Weaver, 2005). People are in relationship with the the notion of personality but goes beyond it.
Creator and with what might be called positive People are not isolated beings but, rather, exist
and negative spiritual forces. These forces are la- in a particular context. Included in this context are
beled differently by various traditions. Examples of climate, work, family, community, culture, and his-
negative forces are signified by such terms as “bad tory (Cross, 1997). As part of their journey, people
luck,” “evil spirits,” “ghosts,” and “the devil” (Cross, are born into a particular family that exists in a
1997). Although typically unseen, these forces are community that has a unique culture and history.
real and influence people for both good and bad in In turn, this context or environment shapes people
this material dimension of existence. in various ways (Weaver & Brave Hart, 1999). For
During their human journey, people exist in a instance, trauma, unemployment, and crime typically
physical body. As is the case with our spirits, many have a negative impact, whereas Native traditions,
factors also affect our physical condition (Graham, family members, and tribal elders often have a posi-
2002). Included among these are genetics, age, tive influence.
nutrition, sleep, physical fitness, and substance use With this being said, it is also important not to
(Cross, 1998). Although some characteristics, such romanticize Native cultures, as some members of
as genetic makeup, are more difficult (if not impos- the dominant culture have done (Weaver, 2005).
sible) to change, others, such as nutrition or physical As is the case with all cultures, Native cultures
fitness, can be changed with relative ease. have strengths and weakness. Although belief in
Interconnected with both the spirit and the body a transcendent spiritual reality is often an asset, it
is the mind (Coates et al., 2006). It is important to can also be a limitation. For example, some Native
emphasize that “mind” in this context represents a clients can understand the notion of bad luck in a
broader understanding than is typical among western deterministic manner that functions to unduly limit

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choices that would be legitimate within a given tribal each area has equal weight. Wellness occurs when
context. Balance is central to evaluating cultures and each area is functioning in harmony with the other
to promoting wellness. areas. Although balance and harmony are related,
intertwined constructs, they can be distinguished
Balance as the Key to Wellness (Cross, 2007).
As implied in the previous section, spirit, body, Balance is a natural state that results from the
mind, and context are interconnected (Coates et normal processes of stimuli and response, drive and
al., 2006; Gilgun, 2002). Consequently, change in drive satisfaction, and complex system interactions.
one area influences other areas (Lowery, 1998). For Some degree of balance occurs naturally among
example, the sudden onset of unemployment may the areas depicted in Figure 2, with or without
produce a sense of sadness and anxiety, which is intervention.Without intervention, balance may be
augmented by bad spirits. In turn, this state may result functional but not necessarily optimal. For example,
in a loss of appetite and sleep, further exacerbating children in an alcoholic family may develop coping
an already precarious mental state. Although some strategies that maintain some form of balance in
Western perspectives would see a linear connection their given situation but also leave them vulnerable.
between unemployment, sadness and anxiety, and As long as humans survive, some form of balance
loss of appetite and sleep, within a Native context exists naturally.
these events are conceptualized in a more circular, Harmony, conversely, requires effort. Harmony
spherical manner in which each event is viewed in results from the active pursuit of more optimal or
relationship to the others. positive balance.This process entails the use of self-
Health and well-being are the result of the discipline and some forms of cultural, spiritual, or
complex interplay among our spirituality, physical mental practices or therapeutic interventions, such as
status, cognitive and emotional processes, and envi- those depicted in Figure 2 (for example, ceremonies,
ronments (Cross, 2001). When all four areas are in memorials). Ideally, the process creates a condition in
balance, we are said to be healthy. This relationship which each of the quadrants generates positive en-
is depicted in Figure 2. As can be seen in the figure, ergy. The energy of the whole system then becomes

Figure 2: Balance and Harmony as the Pathway to Wellness

Spirit Body

Ceremonies Nutrition
Rituals Sleep
Dreams Exercise
Prayer Recreation

Context Mind

Family Storytelling
Elders Reminiscing
Culture Remembering
Traditions Memorials

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greater than the sum of its parts.When in harmony, broad resonance across tribes, interventions designed
people thrive, are resilient beyond expectation, and to promote balance and harmony will vary consider-
contributes in a synergistic manner to those around ably from tribe to tribe and person to person.
them with their energy. With these cautions in mind, these sample in-
A number of practice implications flow from terventions are relatively representative of the types
this understanding of wellness. As stated earlier, of practices that might be used to foster wellness.
people are usually able to maintain some form of In some cases, the nature of the intervention is
balance and, thus, are able to function in a generally readily apparent. A case in point would be a client
healthy manner. Health and wellness, however, are needing better nutrition, extra sleep, more exercise,
not always preserved as people move through life. additional recreation, or some other type of inter-
In such cases, some Native American clients will vention designed to restore harmony in the realm
encounter mental health professionals (Gone, 2004; of the body.
Limb & Hodge, 2008). In the areas of mind and context, the interventions
may be more unfamiliar. Storytelling, reminiscing,
Implications for Mental remembering, and memorializing are traditional,
Health Professionals mind-oriented interventions that can engender
Mental health professionals are typically trained wellness by selectively emphasizing certain experi-
to isolate problem areas in human functioning, for ences, values, and feelings. For instance, reminiscing
which interventions are then developed.The prob- about past events in which problems were success-
lem is commonly thought to exist with or within fully overcome can help bring harmony to the
the person in some sense. A practitioner working mind by instilling hope that present difficulties can
from a cognitive perspective, for instance, attempts be overcome.
to correct a client’s unproductive thought patterns As noted, the person exists in a given context,
(Ellis, 2001). The problem, from this perspective, is which typically includes family, elders, culture,
with the client, specifically her or his schema.View- and traditions. Each environmental factor can be
ing the problem as residing with the person can foster understood and operationalized as an interven-
a milieu in which the person becomes completely tion. Health can often be enhanced, for instance,
identified with the problem, as occurs when people by restoring family unity, consulting the wisdom
are called “schizophrenics” (Hodge, 2004). of elders, or reconnecting individuals with their
The Native perspective discussed in this article culture or traditions.
calls for a completely different way of addressing Although not listed as such, it should also be
problems. Rather than treating the person, the healer noted that more traditional therapeutic interventions
treats the balance (Cross, 1997). The problem lies might also be used in the areas of mind and con-
not within the person but in the lack of balance text. A cognitive intervention, for example, might
and harmony among spirit, body, mind, and con- be used to address unproductive thought patterns.
text. Adjusting the balance among these four areas In some cases, a traditional therapeutic perspec-
restores wellness. tive might be used in conjunction with one of the
Healers focus on understanding challenges more traditional tribal interventions to enhance its
through the complex relationships among spirit, effectiveness. For instance, operating from a systems
body, mind, and context. Rather than using a lin- perspective, a structural intervention might be used
ear cause-and-effect framework, healers approach with a family.
challenges using a relational, intuitive framework in Given the intertwined nature of many of these
which all variables are understood to be intercon- interventions, they are often best conducted with
nected (Graham, 2002). Because of the interrelation- other tribal members. For example, clan members
ship among variables, changing one area results in can often facilitate the process of storytelling, in-
changes throughout the larger system. creasing the significance of the exercise. Likewise,
Four sample interventions in each of the four areas reminiscing with tribal elders may help clients to
are listed in Figure 2. It should be noted that these reconnect with their traditions while enhancing
interventions are illustrative and may not be relevant their resilience. Incorporation of tribal members
to all Native Americans. Although the concepts of into the process is particularly important in the
spirit, body, mind, and context are likely to hold area of spirituality.

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Perhaps the most complex set of interventions ten pathologized religious beliefs and categorized
occurs under the rubric of the spirit. Spiritual inter- spiritual phenomena as dysfunctional. Indeed, woven
ventions are often intensely private affairs (Trujillo, into the Enlightenment worldview at a basic, pre-
2000). Many tribal ceremonies and rituals are not suppositional level is an antireligious bias (Gellner,
open to outsiders. Similarly, the sharing of dreams or 1992; Gray, 2008).
prayers is often proscribed outside of tribal circles. Yet for many Native Americans, spirituality is
Although this area is of foundational importance, critical to wellness and healing (Gone, 2004; Stone,
any discussion of spiritual matters must proceed ten- Whitbeck, Chen, & Johnson, 2005). For instance,
tatively and with the utmost caution because of the in one chemical dependency project, many Native
sacred nature of many Native spiritual practices. women linked their decision to stop using substances
As implied in the foregoing, spiritual, psycho- to a spiritual experience, such as a dream, a vision,
logical, contextual, or physical interventions might or a transcendent voice encouraging them to stop
be used to promote balance and harmony. Because using (Lowery, 1998). Restoring harmony with
restoring balance is the crucial issue, it is important the spiritual realm played an instrumental role in
to emphasize that interventions are not necessar- recovery (Lowery, 1998; Stone et al., 2005).
ily aimed at specific problem areas. Rather, healers Implementing a Native perspective in mental
attempt to understand the interplay among inter- health settings will typically require a collaborative
dependent systems, and they design interventions effort. Social workers are required by the NASW
accordingly. Code of Ethics (NASW, 2000) to remain within
This understanding of healing differs dramatically their areas of professional competency. Given their
from that held within the Western therapeutic proj- socialization into the Western therapeutic project,
ect. For instance, using the linear, cause-and-effect they are unlikely to have the knowledge, skills, or
framework of mainstream mental health, a problem training to work with Native clients in the manner
such as chemical dependency is typically addressed delineated in this article.
by developing psychological interventions that Consequently, it will usually be necessary to form
address the mind (Blazer, 2003; Ellis, 2001; Long- working relationships with specialists in Native
abaugh et al., 2005). As we have noted, the use of spirituality and culture. As mentioned earlier, each
such interventions is not necessary proscribed from tribe has a distinct worldview, and, consequently,
a Native perspective. In some cases, a cognitive in- collaborations should reflect this reality (Whitbeck,
tervention may be appropriate. The problem is not 2006). Although the basic concepts presented in this
with the intervention in and of itself but with the article are widely affirmed among Native Ameri-
larger linear, cause-and-effect framework. cans, they are operationalized in various ways. For
In contrast, Native perspectives typically affirm instance, spirituality may be expressed within con-
a more circular, holistic approach. Addictions, for texts as varied as Catholicism, indigenous settings,
example, may be the product of an unbalanced Pentecostalism, the Native American Church, or
relationship with the Creator. In such situations, some combination of these (Gone, 2004).Thus, col-
a cognitive intervention that addresses the mind is laboration may entail working with medicine men,
unlikely to be effective. Rather, the best way to ad- pastors, elders, priests, teachers, or other individuals
dress substance abuse may be a spiritual intervention with specialized knowledge.
that restores harmony between the individual and To identify individuals with whom to collaborate,
the Creator. A renewed spiritual connection with practitioners should consult their clients (Weaver,
the Creator, manifested in the form of a dream, may 2003). Given the diversity of potential collaborators,
play a critical role in recovery from chemical de- social workers must be careful not to favor certain
pendency (Lowery, 1998). Once balance is restored, types of associations that are based on their prede-
the problem is ameliorated. termined notions of what constitutes an appropriate
The interconnected nature of problems is often collaborator. As experts on their own life circum-
difficult for mainstream mental health profession- stances, clients are ideally situated to suggest the most
als to understand because of years of socialization appropriate collaborator to meet their needs.
that have privileged Western scientific knowledge Before such conversations can occur, however, it
claims over spiritual knowledge. As Cross (2001) is usually necessary to spend some time establish-
observed, the Western therapeutic project has of- ing trust (Jackson & Turner, 2004; Weaver, 2003).

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