Aboriginal Health and Wellness by Ian Brown

What is the difference between stress and distress?

In aboriginal communities across Canada today, there is an acute awareness of the need to address mental health problems and issues. In the last ten years this need has become urgent in the light of high rates of suicide, family violence, and mental illnesses such as depression and anxiety. In this article, we will take a closer look at these problems, their causes, and possible solutions to them.
In considering mental health problems on an individual level, we need to make a distinction between two related but different
concepts, stress and distress.

Everyone experiences stress. It is not only normal but within acceptable limits, plays a positive role. An Inuit hunter waiting for a harp seal to appear feels a kind of stress that produces alertness and determination. However there is a difference between day-to-day stress (looking after children, work demands, transportation difficulties, etc.) and distress.
Stress may produce physical and nervous tension but we are still able to cope. When stress becomes too great and lasts too long, we may start to experience distress – a state in which our coping abilities begin to break down. Distress means that stress has gone beyond acceptable limits.

Stress becomes distress when it is:

- unwanted
- unexpected
- ongoing
-due to serious life-changing events or situations
(e.g. family violence, death of a family member,
divorce, separation, a jail term, etc.)

When we experience distress, we are out of balance. In this case, our bodies and minds cry out for some kind of help. This call for help may take many forms such as moodiness, irritability, depression, anxiety, insomnia, or physical symptoms such as stomach upset or headache. In the case of great distress, a more serious imbalance may result. Depression may lead into a numbing of thought processes and unwillingness to act. A sense of meaninglessness may develop into thoughts of suicide. Nervousness and anxiety may intensify to the point of incapacitating fears such as agoraphobia (fear of being in an open space) or obsessive habits (repeatedly washing one’s hands or cleaning the sink due to exaggerated fears about dirt and germs).

If the imbalance becomes too great, good health breaks down, whether on the level of the body, the spirit, the emotions, or the mind. If the load on the nervous system is too great, ‘burnout’ or breakdown can occur, just like in any other electrical system. Mental illness refers to ill health of whatever kind that has affected the emotions, the spirit, or the nervous system (including the mind).

In the case of the aboriginal population, the most serious mental health problems are depression, substance abuse, family violence, high rates of suicide in certain communities, mental disorders, and grief (individual and collective) over multiple losses and disruptions of lifestyle.
Before taking a deeper look at these problems, their causes, and possible solutions, we can gain some perspective by asking the following question:

What are aboriginal perceptions of mental illness?

In the aboriginal tradition, mental illness cannot be seen as a problem separate from the other aspects of an individual’s life. As is demonstrated in the Medicine Wheel, physical, emotional, psychological, spiritual, and environmental health are seen as interrelated.
“The Medicine Wheel or Drum has become a popular symbol for helping First Nations people articulate a definition of health:

The circle represents wholeness and movement or action. Having effective ways and means to satisfy physical and emotional needs, a person is able to focus energies on creating knowledge or working tools which will equip him/her to define, redefine, and pursue his purpose on this earth.”1
In Inuktitut, there is no general term for ‘mental illness’. Disease is seen as a state experienced by the person and not, as in western conception, a characteristic attached to the identity of the individual. Someone is not stuck with a label, e.g. he/she is ‘a schizophrenic’.

The two terms most commonly used by Inuit people when they refer to mental health problems are revealing. Isumaluttuq implies ‘too much thinking’. Such heavy thoughts can lead to depression, anxiety, insomnia, and even violence or suicide. Isumaqanngituq, on the other hand, means literally ‘having no mind’. Typically, this term has been used to describe individuals with severe mental retardation. However, it has also been extended to cover people with severe mental disturbances whose behaviour was clearly unpredictable.

Some people say that there is more tolerance of unusual behaviour in aboriginal (as opposed to non-aboriginal) communities. If this is the case, it has both positive and negative implications. On the one hand, it should be easier to treat and integrate disturbed individuals within the community. On the other hand, such tolerance could be seen as delaying the recognition of serious conditions such as depression and suicidal intentions. Whatever the case, there continues to be much misunderstanding about the nature of mental illness.

There is a great need for public education in this area because of both ignorance and superstition. People do not like to admit problems of ‘mental illness’ exist because of the stigma attached to these words. As in the case of alcohol abuse, there is a sense of shame in admitting to such a problem. It is easier for many people to admit that they have a heart condition than a mental condition.

For example, Dianne Reid, President of the James Bay Cree Cultural Education Centre, put it this way:
“In Cree communities, we see people walking around who are either manic-depressive or schizophrenic, who are feared and shunned by the community. Families are unable to deal with this because of a lack of understanding of these illnesses, choosing to do nothing at all, further alienating and isolating these individuals … sometimes their sense of loneliness and isolation is so great that they call me 15 times a day.”2

Needless to say, if an individual has been sent to a psychiatric hospital in a far-off city, the chances for stigmatization are often increased upon his/her return to the community.

There are also different perceptions of the usefulness of prescription drugs for mental illness. Some people welcome the ‘miraculous’ changes that have occurred due to recent advances in medication for depression and schizophrenia. Others are afraid of both over-prescription and chemical dependency, or that such a focus on individual sicknesses may result in larger social problems being overlooked. This matter will be dealt with in more detail in following sections.

It is hardly the case that there has been agreement on the nature of mental illness and the role of psychiatry in
non-aboriginal circles. Since the 1960s, there has been an ‘anti-psychiatry’ movement based primarily on the theories of R. D. Laing and Thomas Szasz. Some people make the point that even the words psychology and psychiatry derive from the root word psyche, the Greek term for ‘soul’. It is also the name for the goddess Psyche who travels alone to the underworld in order to bring back lost souls. This perception of ‘mental illness’ having to do with soul loss is close to shamanic traditions in which an
unbalanced person was seen as having become dis-spirited (i.e. lost their spirit). It was the shaman’s role to find and bring back the missing spirit.

In some communities, the church has taken on the role of the shaman. For example, in the far north of Canada, churches such as the Pentecostal Church have become popular because it views hallucinations as being an indication of demon possession. It is not unusual to find an individual who has received treatment from (a) traditional healers, (b) a doctor who views the problem as schizophrenia, and (c) the church who would focus on how to exorcise the demon(s).
These differing belief systems can and do produce friction and conflict. “There seem to be battle lines between workers,” said Dianne Reid, who went on to tell the story of a
hospitalized patient diagnosed as suffering from mental, emotional and physical damage. “According to the psychiatrist treating this patient, each of these afflictions had to be treated separately. However, an Elder involved with the case showed that all of these states were intertwined, including a spiritual dimension which was missing entirely from the psychiatrist’s diagnosis. The Elder was able to disentangle the threads and heal the individual.”3

Addressing the Native Mental Health Research Team in Montréal, Dianne emphasized that discussion of aboriginal mental health “should not be about widening the gap between individuals and differing approaches, it should be about widening the circle - at the level of the individual, the community, the nation and the world.” Given the presence of psychologists, psychiatrists, social workers, and healers in many communities, there is a need for a holistic or integrated approach to treating people.