Main Problem Areas
in Aboriginal Mental Health

by Ian Brown
(illustrations by Star Horn)

‘Mental Health / Illness’ are very broad terms.
In this article, we will focus primarily on suicide, family violence and the three main mental disorders of depression, anxiety and schizophrenia.

 

 

[ 1] Suicide

Suicide amongst Aboriginal peoples has been described as an epidemic. The suicide rate among Aboriginal people of all ages is between three and four times higher than among non-Aboriginals. This is a rate that is said to be the highest reported for any culture in the world. Specifically, the suicide rate is 3.3 times higher for Indians and 3.9 times higher for Inuit. For Aboriginal youth between the ages of 10 and 19, the rate is five to six times higher than for their non-aboriginal counterparts. The situation becomes still more alarming when one considers the fact that 38 per cent of all registered Indians are under the age of 15, meaning that if a remedy is not found, the suicide rate may rise still further.


In addition, these statistics do not cover Métis or non-registered Indians and consequently show rates that are lower than is believed to be the case for the total Aboriginal population. It is also estimated that 25 per cent of ‘accidental deaths’ are really unreported suicides, a fact that would result in further under-reporting.


In 1992, in the community of Big Cove, New Brunswick, there were 7 suicides and 75 attempted suicides. Community caregivers formed a group to look into how the community could take responsibility for improving the situation. A week-long community gathering for mourning and healing was arranged. As an example of the ‘widening the circle’ approach, the process combined Mi’gmaq spirituality, Christianity and western psychotherapy.

Statistics are one thing. Hearing the voices of those affected is another. Here are the words of one who lives in a community that has a high rate of suicide:
“My father committed suicide … I’ve heard it and I’ve seen it before, in my brother, in my daughter and in my brother-in-law. … I’ve seen my brother’s writing … he wrote notes … and he tried to hang himself. My daughter tried that too. She tried to hang herself. And my brother-in-law has stabbed himself. I mean, cut himself up. My husband talks about suicide. And I myself have thought about it. I know I won’t do it, but there are days and times that it comes to thinking about it. For me, I don’t say anything to anybody. I don’t say I want to commit suicide … I feel like disappearing, maybe without dying or with dying, I don’t know. I mean, there are times when I think about how I’m going to do it. Am I gonna hang myself? Am I gonna overdose? Do I slash my wrists? What, what, what? How will I do it? You just get tired of what’s happening around you.”4

[ 2 ] Family Violence

Like the term ‘mental illness’, family violence is broad in its meaning. It covers sexual abuse, physical abuse, emotional and psychological abuse, and neglect in the area of child care. A short time ago, in February 2003, the National Indigenous Sexual Abuse Conference was hosted by the Mikisew Cree First Nation and held in Edmonton, Alberta. The conference coordinator, Allan Beaver, made the point that “the prevention of sexual abuse is a long-term effort and it requires fundamental changes to attitudes and values of individuals and society as a whole. We can start by talking about it and begin to take one step at time.”5


Within the last decade, the Canadian Panel on Violence Against Women has surveyed both Aboriginal and non-Aboriginal communities across Canada. Here are some of their findings:

 
-Hospital and social service reports show an extremely high rate of violence against women and children in both Aboriginal and non-Aboriginal communities.
-In the 1990s, the occupancy rate at Iqaluit’s women’s shelter tripled.
-Sexual assault reports in the Northwest Territories are four to five times higher than in the rest of Canada. Those at highest risk for sexual abuse were females from 13-18 years old, followed by girls aged 7-12.
-A Northwest Territories survey found that 80 per cent of girls and 50 per cent of boys under the age of 8 had been sexually abused.
-A survey in southern Ontario found that 71 per cent of an urban sample and 48 per cent of a reserve sample had been assaulted by current or past partners.
-Seventy-five to ninety per cent of women in some Aboriginal communities are physically abused.
-The Ontario Native Women’s Association reported that from a total of 104 completed questionnaires, 80 per cent of respondents reported personal experience of family violence, approximately eight times the rate estimated for Canadian women as a whole.
-The kinds of abuse identified as features of family violence were mental and emotional (89 per cent), physical (87 per cent), and sexual (57 per cent).
-Serious effects of abuse included aggressive behaviour, hyperactivity, antisocial behaviour, social withdrawal, learning disabilities, somatic symptoms, low self-esteem, depression and P.T.S.D. (post-traumatic stress disorder).

In a presentation called ‘Surviving the Abuse in Cree Society’, Marilyn Bearskin makes these additional points: Native women who are being abused often turn to alcohol and drugs, neglect their children, households and themselves, and often attempt suicide. There is a pattern of abuse and neglect that continues from one generation to the next. People within the community often do not take domestic violence seriously. When women finally do leave their abusers, they are often faced with harassment, rather than support from the community. Finally, there is an absence of programs and counselling for victims of abuse.7

[ 3 ] Depression

There is general consensus that there are high rates of major depression among Native groups. For example, a recent survey of leaders of 57 reserves in Manitoba found that 47 per cent of respondents considered depression to be a serious problem in their community.8 In the Baffin region, Young and colleagues (1993)9 reviewed records on 581 referrals for psychiatric consultation and found that reasons for referral were:

depression: 27.9%
suicidal thoughts / attempts: 24.4%
relationship / family problems: 14.7%
grief reactions: 10.5%
violent / abusive behaviour: 9.5%
psychotic or bizarre thinking: 7.5%


 A Story
(summarized from ‘The Story Of Don’,
published by the Aboriginal Health Association of BC)

Don lived in a run-down rooming house on the East Side. His room consisted of only a foamy mattress - filthy and rank, one chair and a box for clothes that resembled rags.
Don wasn’t always an alcoholic. He grew up in a home with two hard-working loving parents and close-knit siblings who looked after each other. Things changed for Don when he started school. For him, school represented pain and confusion, and hurt. Along with his friends and relatives he was ridiculed, called down, pushed around and beaten up by the white boys. He did not know how to tell his parents so he kept it a secret. He learned how to withdraw into himself so he wouldn’t feel the pain.
When he was ten years old his neighbour abused him. That fateful day changed Don forever. He changed from a carefree, happy-go-lucky boy into a quiet, lonely one. He entered the cold, dark, hopeless world of depression. He kept to himself, did not do well in school, experimented with drugs and alcohol and had his first suicide attempt at the age of twelve. He did all these in vain - he could not forget or talk about what happened to him.
Depression was a constant companion throughout his teenage and young adult years. Don’s emotions flipped in and out of hopelessness, anger, fear and guilt. He did not know how to ask for help. He could not even talk about what had happened to him. He quit school in grade nine and ran away to the big city. His parents did not know how to help him or what had changed him. He refused to see his family.
Don tried to cover up his depression and suicidal tendencies by self-medicating with drugs and alcohol. His days were spent walking the streets begging for money and drinking cheap rice wine. His little room became a flophouse for people he met on the street. Don spent ten years on skid row. One day he woke up and found he could not move. His body had become so badly poisoned from alcohol he was barely recognizable. His face was swollen and puffy, he had lost at least sixty pounds, his stomach was distended because his liver was losing the battle to alcohol and his body, including his eyes, was yellow. That was how his parents found him.

This story illustrates the realities of depression and
also how substance abuse, depression and suicide can become intertwined.

 

[ 4 ] Anxiety Disorders

Individuals with anxiety disorders experience excessive fear or worry. This can cause them either to avoid situations that might set off the anxiety or to develop compulsive rituals that lessen the anxiety. Everyone feels anxious in response to specific events - but individuals with an anxiety disorder have excessive and unrealistic feelings that interfere with their lives in their relationships, school and work performance, social activities, and recreation.

Types of Anxiety Disorders

(a) Generalized Anxiety Disorder (GAD)
Excessive anxiety and worry about a number of events or activities occurring for a period of at least six months with associated symptoms (such as fatigue and poor concentration).

(b) Specific Phobia
Continuing fear of certain objects or situations (such as flying, heights, cramped spaces, etc.).

(c) Post-Traumatic Stress Disorder
Flashbacks, persistent frightening thoughts and memories, anger or irritability in response to a previous terrifying experience in which physical harm occurred or was threatened (such as rape, child abuse, war or natural disaster).

(d) Social Phobia, also known as Social Anxiety Disorder
Exposure to social or performance situations, such as public speaking, usually sets off an immediate anxiety response that may include palpitations, tremors, sweating, gastrointestinal discomfort, diarrhea, muscle tension, blushing or confusion, and may cause a panic attack in severe cases.

(e) Obsessive-Compulsive Disorder
Obsessions: Persistent thoughts, ideas, impulses or images that cause marked anxiety or distress. Individuals with obsessions usually attempt to ignore or deny such thoughts or impulses or to counteract them by other thoughts or actions (compulsions).
Compulsions: Repetitive behaviours (such as hand washing, ordering or checking) or mental acts (such as counting or repeating words) that occur in response to an obsession.

(f) Panic Disorder
Presence of repeated, unexpected panic attacks, followed by persistent concern about having additional attacks. Worry about the meaning of the attack or its consequences.
Panic disorders can come from a feeling of being trapped, for example not being able to escape an unpleasant social situation.
The basic feature of the panic attack is an experience of intense fear or discomfort that is accompanied by at least 4 of the following 13 symptoms:
~ Palpitations, increased heart rate
or pounding heart
~ Sweating
~ Trembling or shaking
~ Sensations of shortness of breath
or smothering
~ Feeling of choking
~ Chest pain or discomfort
~ Nausea or abdominal distress
~ Dizziness, unsteadiness,
light-headedness or fainting
~ A sense of unreality and confusion
over who you are
~ Fear of losing control or going
crazy
~ Fear of dying
~ Numbness or tingling sensation in
hands and feet
~ Chills or hot flashes

[ 5 ] Schizophrenia

In a recent report from Health Canada, schizophrenia is defined and described as follows:

“Schizophrenia is a brain disease and one of the most serious mental illnesses in Canada. Common symptoms are mixed-up thoughts, delusions (false or irrational beliefs), hallucinations (seeing or hearing things that do not exist), and bizarre behaviour. People suffering from schizophrenia have difficulty performing tasks that require abstract memory and sustained attention. The signs and symptoms of schizophrenia vary greatly among individuals. There are no laboratory tests to diagnose schizophrenia. Diagnosis is based solely on clinical observation. For a diagnosis of schizophrenia to be made, symptoms must be present most of the time for a period of at least one month, with some signs of the disorder persisting for six months. These signs and symptoms are severe enough to cause marked social, educational or occupational dysfunction. The Canadian Psychiatric Association has developed guidelines for the assessment and diagnosis of schizophrenia.”10

Symptoms of Schizophrenia
- Delusions and/or hallucinations
- Lack of motivation
- Social withdrawal
- Thought disorders

Over the years, there has been much disagreement about what schizophrenia is, and is not. For followers of Thomas Szasz, R.D. Laing and the anti-psychiatry school, the symptoms described above could all be indications of a transforming experience, a ‘breakthrough’ rather than a ‘breakdown’. Laing suggested that the term ‘schizophrenia’ be replaced by ‘metanoia’ – meaning ‘change of mind’ or ‘conversion’. More recently, another famous psychologist, Stan Grof, instigated an organization called the ‘Spiritual Emergency Network’, to provide an alternative view and support system for those in mental turmoil. Meanwhile, a Christian fundamentalist might see these symptoms as signs of ‘spirit possession’.


According to traditional Inuit culture, some illnesses were considered to be the result of an interaction between the soul of a person, place or thing and the individual affected by the illness. Humans are considered to have three types of souls – the name soul, the life breath, and the shadow soul. In the past, each type of soul was subject to treatment by shamans to cure disease. Certain types of abnormal behaviour and mental illness were seen as due to the interaction between souls and spirits of other people or animals.
Three types of possession resulting from these interactions have been identified: Uuttulutaq, Nuliarsalik/Uirsalik and Christianized ‘Satanic’ possession.