1 Dec 2023
Making the Invisible Visible: Intersecting Psychedelics, Intergenerational Trauma, and Critical Consciousness
Creating Pathways: History and the Impact of Health Care for Native Americans in the Psychedelic Renaissance
By Belinda Eriacho, MPH, MT
MAPS Bulletin: Volume XXXIII Number 3 • 2023
As I reflected on the MAPS PS 2023 conference, I could not help to think and hope that future psychedelic conferences will include more topics and discussion on health policy, psychedelic research, education and accessibility with a focus on Native Americans.
To understand the current reality of Native American healthcare, one needs to understand the historical framework created by federal agencies, laws, and policies. This understanding is essential for developing culturally sensitive approaches to psychedelic research, policy, and education inclusive and beneficial to Native American communities. By centering the experiences and needs of these communities, the psychedelic renaissance can work towards partnership with Native communities, organizations, individuals, and tribal leaders. Tribal nations and Indigenous people should be afforded the opportunity to voice their own concerns with respect and trust, rather than by allies pretending to understand our issues.
US Historical Perspective
The responsibility for the “Indian” initially fell to the Secretary of War. In 1824, the Secretary of War established the Bureau of Indian Affairs (BIA)[1] with the subsequent Snyder Act of 1921, solidifying the federal government’s responsibility for the “relief of distress and conservation of health” for Indian tribes. By 1954, Congress transferred the responsibility of Native health care from the Department of the Interior (BIA) to the Department of Health and Human Services (HHS), leading to the creation of the Indian Health Service (IHS).[2] In 1976, the Indian Health Improvement Act was created to decrease the gap between Native American health conditions and those of the total population. Under this act Congress provided incremental funding for health services and health facilities over a seven-year period, which included urban health centers.[3]
There are 574 federally recognized tribes located in the United States, each with its own culture and language. For approximately 200 years, the federal government has had a trust responsibility to federally recognized tribes. [4] This trust responsibility implies a moral obligation of the highest responsibility and trust[5] to Native American tribes and legally administrates financial obligations, which include the provision of health care services. [6] The treaties signed between tribes and the US Government outlined the obligation to provide health care services as compensation for the seizure of tribal nations’ land and resources.
A comprehensive approach to healthcare equality should recognize and rectify historical injustices while actively engaging with and respecting the unique perspectives and needs of Native communities.
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Disparities in Health Care
The disparities in health outcomes Native communities face today are deeply rooted in a long history of injustices committed against Indigenous people. These injustices include historical traumas such as: forced relocation, the removal from ancestral land, genocide, cultural assimilation, and boarding schools.[7] These historical abuses have had significant and lasting impacts on the health and well-being of Native peoples in this country. They have also contributed to mistrust of healthcare systems, the perpetuation of intergenerational trauma, cultural disconnect, and the loss of traditional family systems and diminished cultural identity.
In the twentieth century, the realities of our communities are:
- Life expectancy of Native American/Alaska Native individuals is 5.5 years less than that of other races in the United States. This significant gap in life expectancy underscores the urgent need to address the underlying factors contributing to this disparity such as limited healthcare access, socioeconomic inequities, unresolve trauma, and higher rates of chronic diseases and other health conditions.
- Heart disease, cancer, malignant neoplasm, unintentional injuries, and diabetes are the leading causes of Native American deaths (2009-2011).
- Native Americans mortality due to chronic liver disease and cirrhosis, diabetes mellitus, unintentional injuries, assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases is higher than other Americans.[8]
- The suicide death rate for Native Americans in America between the ages of 11-19 is more than double that of non-Hispanic whites.
- Compared to non-Hispanic whites, nearly 3 times as many Native people had no health insurance, 5.9 percent compared to 14.9 percent. Approximately 43 percent of Native people in America rely on Medicare or public coverage. [9]
According to Dr. Joh Perez, IHS does not provide ongoing quality psychiatric care. Instead, the approach adopted is one of responding to immediate mental health crisis and stabilizing patients until the next episode. [10]
The amount of needless suffering and loss of life for Native Americans related to preventable and treatable illness make IHS funding a matter of social justice and civil rights, and this issue needs to be a national priority for all public health advocates.[11] Resolving these health disparities require a broader look at social and economic inequalities by addressing social determinants of health, such as poverty, education, housing, and on-going systemic racism and oppression, funding of health programs promised to tribal nations, as well as promoting cultural literacy and competency within organization and institutions.
A Pathway Forward
Creating pathways that helps build a foundation for psychedelic-assisted therapies for Native communities and organizations requires a two-prong approach involving Native American communities and individuals, and psychedelic science organizations and medical/educational institutions.
Native American individuals should have an active role by participating on advisory and psychedelic organization boards that will help influence and close the gap on health disparities in Native communities.
The necessary steps tribes and Native American professionals can take to create pathways for bringing psychedelics to tribal communities, include education, research, advocacy, participation, and policy creation. First, tribes and health care providers serving these communities need to educate themselves about psychedelics and the potential for psychedelic-assisted therapy.
Second, they need to seek out and push for opportunities for inclusion[12] and participation, including current clinical trials. In addition, psychedelic research projects utilizing Indigenous research methodologies should be considered, funded, and led by Native American researchers, consultants, and advanced degree seekers. This may require adjustments to the outcomes and goals of the research project to ensure Native American communities directly benefit. Lastly, as states begin the roll out of legislation specific to the use of psychedelics therapies, Native American individuals should have an active role by participating on advisory and psychedelic organization boards that will help influence and close the gap on health disparities in Native communities.
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For those in Western science and players in the psychedelic renaissance, this action first requires acknowledgement of the contributions of Indigenous people for stewarding and holding the wisdom of these sacred medicines. To avoid perpetuating historical inequities and marginalization, it is vital that any developments in psychedelic field consider the diverse cultural context and experiences of Native communities. It also requires active involvement of Indigenous people at the table in board rooms, clinical trials, educational institutions, policy making institutions, and in therapeutic settings. Participation needs to go beyond tokenism to allow the live experiences and wisdom of Indigenous people to infuse and inform the movement, rather than simply checking a diversity box or promoting false inclusivity.
Additionally, the issue of Indigenous identity must be addressed and clarified so that the proper financial resources can be allocated to create access to these sacred medicines for healing in Indigenous communities and elsewhere. Consideration must also be made for our relatives of mestizo lineages and whose ancestral roots have been severed, and who are trying to reconnect to them.[13]
Unsatisfied by modern America’s social and cultural fabric, often people reach for a salve in the familial, spiritual, reverent nature of many of our Indigenous communities and is often overly-romanticized, idealized, and casts us in a role we cannot fulfill for others
Within this movement of psychonauts, retreat shamans, there are also “pretendians”[14] among us that must be spoken about. We are all familiar with the topic of cultural appropriation and yet we are uncomfortable talking about the elephant in the room. Specifically, those who are non-indigenous, practicing ethnic fraud and pan-indigeneity[15] to legitimize themselves as medicine carriers and healers. In Indigenous communities, we are aware of individuals purporting to be Indigenous or to speak on our behalf. These individuals claiming to be indigenous do a disservice to our communities because they are profiting from our cultures and take up space meant for indigenous voices undermining our sovereignty[16], as well as gaining social capital, academic clout, and financial reward.
In federally-recognized tribes, it requires reliance on blood quantum in order to prevent outsider exploitation and to ensure tribal sustenance.
What is at the core of Indigenous masquerading? I’ve observed that many westerners have a deep and abiding yearning for cultural identity and belonging—which was often severed when emigrating to America. Unsatisfied by modern America’s social and cultural fabric, often people reach for a salve in the familial, spiritual, reverent nature of many of our Indigenous communities and is often overly-romanticized, idealized, and casts us in a role we cannot fulfill for others—being as we are struggling even to meet our own basic needs.
Solutions require building relationships with indigenous communities is a long-term commitment and one that takes time to build trust. We can unlearn and relearn how to be together in solidarity. It must begin with each person reconnecting to their own heritage and lineage first. Only then can our cultures touch one another.
Conclusion
As discussed, recognizing the historical context and current realities of Native peoples through their lived experiences is essential to understanding the ongoing challenges to access healthcare and reduce health disparities. Additionally, the ongoing health disparities of Native American is evidence of ineffective health policies and systems, while the lack of full appropriations by Congress continues to exacerbate the problem. These are important factors to consider when advancing psychedelic initiatives with Native American communities.
As the psychedelic renaissance continues to unfold, there are pathways that can be taken to bring the use of psychedelic-assisted therapies to the original peoples of this country by working together in a manner that is built on respect, trust, collaboration, and reciprocity.
References
(1) U.S. Department of the Interior, Bureau of Indian Affairs (BIA). October 15, 2023. URL: https://www.bia.gov/bia
(2) IHS, First 50 Years of the Indian Health Service, supra note 302, at 8. Transfer Act, Pub. L. No. 83-568, § 1, 68 Stat. 674 (1954).
(3) Edited by Francis Paul Prucha. Documents of United States Indian Policy. University of Nebraska Press. P. 279. 2000.
(4) U.S. Department of the Interior, Bureau of Indian Affairs (BIA). October 15, 2023. URL: https://www.bia.gov/bia
(5) Seminole Nation v. United States, 316 US 286 (1942).
(6) Warne, Donald, MD, MPH, and Frizzell, Linda Bane, PhD. American Indian Health Policy: Historical Trends and Contemporary Issues. American Journal of Public Health. Supplement 3, 2014, Vol 104, No. S3. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035886/pdf/AJPH.2013.301682.pdf
(7) Eriacho, Belinda. Intergenerational Trauma: Native American’s Inherited Legacy. Multidisciplinary Association for Psychedelic Studies. June 24, 2020.
(8) Health and Human Services HIS, Fact Sheet: Indian Health Disparities. October, 2019. URL: https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/factsheets/Disparities.pdf
(9) Mental Health America. Native and Indigenous Communities and Mental Health. URL: https://www.mhanational.org/issues/native-and-indigenous-communities-and-mental-health
(10) Jon Perez, director of behavioral health, Indian Health Service, interview in Rockville, MD, July 21, 2003 (hereafter cited as Perez interview)
(11) Warne, Donald, MD, MPH, and Frizzell, Linda Bane, PhD. American Indian Health Policy: Historical Trends and Contemporary Issues. American Journal of Public Health. Supplement 3, 2014, Vol 104, No. S3. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035886/pdf/AJPH.2013.301682.pdf
(12) Eriacho, Belinda. Guideline for Inclusion of Indigenous People into Psychedelic Science Conferences. June 22, 2020. Chacruna Institute. URL: https://chacruna.net/guidelines-for-inclusion-of-indigenous-people-into-psychedelic-science-conferences/
(13) Ibid.
(14) Nagler, Jilip. The Pretendian Among Us. Our Lives. March 1, 2023. URL: https://ourliveswisconsin.com/article/the-pretendian-among-us/
(15) Ibid.
(16) Quinn, Diana. Mestizo Identity and Decolonial Psychedelic Futures. Chacruna.net. July 20, 2021. URL: https://chacruna.net/mestizo_identity_decolonialization_psychedelics/
Belinda Eriacho, MPH, MT
Belinda is of Dine’ (Navajo) and A:shiwi (Pueblo of Zuni) descent.
She is the founder of Kaalogii. She has been instrumental in connecting indigenous wisdom and innerstanding with psychedelic science. She brings a unique gift of storytelling into her presentations and writings as part of this bridging process.
She is an author of numerous published articles and a contributing author to “How Psychedelics Can Help Save the World: Visionary & Indigenous Voices Speak Out” and Psychedelic Justice: Toward a Diverse and Equitable Psychedelic Culture.
