An open letter to future psychologists

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AUTHOR’S NOTE: This paper discusses looking to Native American psychology to critique Western forms of psychology. It should be stated that the author is not themselves Native American, and that they are not trying to claim as such through this paper.

Mental healthcare and support have been a part of my life since before I’d turned six years old. I found myself moving from therapist to therapist as I grew up, unable to understand why I was treated so differently by my peers and the adults around me. I’d get asked to talk about my thoughts and what I saw, only to be put on a new medication or sent to a new therapist who could properly treat my mental illness. Bullying came as a side effect of going to therapy, and being different than my peers meant being unable to fit in and thus led to more bullying.

I can’t even begin to describe how I felt as a six year old child being told I had something wrong with me and that I needed to see someone to essentially fix me and make me normal like my peers. I experienced the world differently than others, and that was cause enough to be placed under the care of therapists and psychiatrists who tried medication after medication to fix what was wrong with me. The idea that “good mental health” was the end goal and that meant either curing me of my divergent thinking and experiences of teaching me how to hide them from public view is a very Western or Eurocentric view within psychology (Hodge, Limb, & Cross, 2009, p212) as opposed to working on viewing the person as a whole being often left me feeling like I was nothing beyond my diagnoses. By the time I’d entered my teenage years I’d learned how to fake taking my medication, and had learned that telling my therapists the truth was a surefire way to land me in more therapy…so I started lying. I honestly couldn’t even imagine what life would be like without the heavy list of mental illness diagnoses I’d been burdened with when asked by providers. It took until my 30s before I was finally listened to and my experiences treated as part of me and not something that needed to be hidden or fixed.

Gone were the days of hiding that I heard voices or saw people others couldn’t see. Gone were the days of hiding that I dealt with intrusive thoughts and struggled sometimes to see the same reality that others saw. My therapist took the time to listen to me, to understand what I was talking about from my view instead of one of the hundreds of books at her disposal, and to see me as more than my laundry list of diagnoses. I was seen as a whole person and treated as a whole person instead of just looking at my mental illnesses and going,

“You’re broken, you need fixing.”

I write this not to have you pity me or to shame any prospective therapists from following along with what they were taught; I write this to push for you and others to expand your training and your education. We too often try to separate the mental from the physical when it comes to care, treating the symptoms as they arrive instead of trying to take a holistic approach to healthcare. While it is known that mental illness can lead to physical illness (MacMillan, 2017), and that the reverse is also possible, most cases of care attempt to separate the physical from the mental and only treat one at a time. Without looking at the entirety of the person seeking treatment, this can lead to misdiagnosis and sometimes completely overlooking the underlying cause of a person’s issues.

When we look at mental healthcare as a whole, there is an extreme bias skewing towards Eurocentric/Settler Colonial (read: white) education, care, and treatment modalities. Because of this I wish to look at three areas in regard to mental healthcare in this letter: Access to care, racial/ethnic bias in care, and the holistic approach to care. The primary focus will be looking between care I am able to receive as a white person versus the care my partner is able to receive as an Indigenous man.

I admit that I come from a position of privilege when it comes to receiving mental healthcare as a white person raised in an upper middle class household, and it is from this position of privilege that I am writing to prospective therapists and those entering the field of psychology. Despite the lack of “good” care that I received growing up and into my adulthood, I had access to care and the ability to seek out someone who would be like me when attempting to access care. I can readily assume that any therapist I see will have been trained in how to work with someone like me (a white person) and I can guarantee that my treatment will be one that is well studied and wide reaching in regards to people like myself. I can go on almost any therapist search website such as the “Find a therapist” feature on Psyhcology Today’s website and find a therapist who not only looks like me, but is more than likely able to empathize with my issues in a way that will form a rapport rather than come off as an outsider looking in.

When I contrast this with my partner’s ability to access care as an Indigenous man, it is easy to see just how much more difficult it is for him to find care. Utilizing the same search website, searching for a therapist who is trained in working with Indigenous people only yields six results, as opposed to over 120 results in the Jackson County/Josephine County area that I would have access to. When we then narrow it down by insurance coverage (we both have Medicare) his results drop down to just two people in a two county area while mine drops to around 40. Even though my results dropped by 80 therapists, I still have a far larger pool of therapists to reach out to should I need care. For my partner, the next closest therapist who has training to work with Indigenous people is over two hours away from where we live. Of all of those trained to work with Indigenous people in our area, not a single one of them is themselves Native American or Indigenous, and it is believed that the total number of “doctorate-level American Indian psychologists in the U.S. Is estimated at less than 200” (Benson, p56, 2003) meaning that if my partner did wish to find a therapist like himself in an ethnic sense, he’d be hard pressed to even find one in his state, let alone county.

However one needs to take into account that my partner and I are living in an area where mental healthcare is readily accessible. While there is an absence of therapists who are trained in working with Indigenous individuals, there is still access to mental healthcare in general, something that cannot be said about many areas such as reservations and rural communities where the population is primarily Native American or Alaskan Native. Despite programs such as INPSYCH attempting to fill the gap through funding scholarships and outreach programs for college and high school students in areas such as North Dakota and Oklahoma (Benson, 2003, p56) the communities deemed to be the most in need of mental healthcare are often left either with therapists who are untrained in dealing with populations that do not fit within the Eurocentric education provided, or the training given is lacking in regards to the population the therapist is attempting to serve.

The primary provider for mental healthcare among Indigenous populations in the United States is the IHS (Indian Health Service), specifically through the Office of Mental Health, a department in charge of roughly 1.5 million individuals throughout the United States (Gone, 2004, p11). Due to underfunding of the department as a whole, and only 7% of the budget going to mental health and substance abuse treatment (Gone, 2004, p12), most areas most in need of care are either so underfunded that access is nearly non-existent, or it doesn’t exist at all. Imagine how it must feel to be in need of services, only to be told either that you don’t have access that you are legally required to have or told that your wait time will be so long that you might as well go without care. This is something that many in areas where care is difficult to access are left to deal with despite the government being required to provide care for these people with other providers only being expected to step in when the IHS fails to provide the needed care.

Access to care should be available to all who need it, not just something that is available on paper but not in real life.

This is something that many of us take for granted who live in urban areas or more rural but still well connected areas of the United States. For many of us, we can just hop in the car and drive a few extra miles to get the care we need if it’s not available in our area. Contrast this to people living on reservations or in rural areas where the next closest community might be hours away at best, and an that’s only if one has access to a vehicle that can make the trip and the money for gas to make said trip. While we are starting to see a rise in telemedicine which allows for patients to reach providers who are further away than they’d normally reach out to, this again requires access to internet, reliable phone lines, and in a few cases, reliable electricity. Despite the rise in programs to entice Indigenous people to enter the field of psychology and become therapists, if the areas they would be providing care for are so underfunded and unable to provide an area for the therapist to work, it doesn’t matter how many therapists we have available. Access to care means not only that the therapists and providers are there, but that patients can readily access them in a way that will allow them to receive the care they need (Wood, Burwell, & Rawlett, 2018).

I want to call back to my partner’s attempts to receive mental healthcare for a moment. When he was searching for a provider, he often found himself with therapists who either didn’t take into account his ethnicity or they tried to push for treatments that did not fit for his tribe. In a couple of cases he was given suggestions that while they would have been a treatment for someone of the Lakota people they would not have been something that his people (Apache) would have done. It was assumed that one tribe or nation’s treatments would work for all other tribes and nations through the pan Indian lens, ignoring how diverse and varied practices are among the various tribes and nations. Despite his therapist having been trained to work with Indigenous people, the training wasn’t accurate for his needs nor did it take into account that despite him saying he’s Native American it didn’t mean that his care could be identical to another patient from another tribe or nation.

There are similarities when it comes to general education in psychology, where in the beginning one receives a very broad spectrum of topics to learn about before choosing to specialize in certain areas in their own practice. A therapist specializing in CBT, EMDR, and trauma therapy would write all of that out as areas of training when providing information to prospective clients, yet it is often assumed that writing “Native American” for an area of specialized care and training is sufficient. For example, if a therapist is trained to work with Lakota, Blackfoot, and Dakota peoples, they should state as such instead of simply stating “Native American” as those are only three of over 500 federally recognized tribes and nations in the United States.

One’s bias must also be taken into consideration when working with clients who are considered to be non-white, including Indigenous, Black, Asian, Hispanic, and Latine peoples. Attempting a colorblind approach to care doesn’t lead to better care and provides caregivers with an excuse to remain ignorant of cultural beliefs and practices (Williams, 2013). This includes not taking the time to understand the racist or harmful history behind certain phrases and sayings. Using phrases such as “circle the wagons,” “off the reservation,” and similar are all deeply tied in racism and colonialism and can push patients away due to the lack of understanding in how damaging and traumatizing those phrases can be (Robertson, 2013).

Another area where problems arise is the Eurocentric or Western forms of treatment and therapy versus traditional non-Western forms of healing and treatment.

For many people studying psychology, the non-Western Indigenous forms of healing and medicine might look like a form of pseudoscience or even something that might be termed “woo” in every day conversation and compared to practices such as crystal healing or tarot reading. This then calls for a need for not only further education, but the need for people to set aside preconceived notions and beliefs about what care should look like on top of working to educate oneself on cultural differences. This means extra work for the person wishing to work with Indigenous peoples in a mental healthcare setting, and that education has to be ongoing on top of their own continuing education requirements. When attempting to bridge the gap between Western and non-Western forms of care, Derald Wing Sue and David Sue have pointed two a set of guidelines to help Western trained therapists:

  1. Do not invalidate the indigenous belief systems of your culturally diverse clients.
  2. Become knowledgeable about indigenous beliefs and healing practices.
  3. Realize that learning about indigenous healing and beliefs entails experiential and lived realities.
  4. Avoid overpathologizing and underpathologizing a culturally diverse client’s problems.
  5. Be willing to consult with traditional healers or make use of their services.
  6. Recognize that spirituality is an intimate aspect of the human condition and a legitimate aspect of mental health work.
  7. Be willing to expand your definition of the helping role to community work and involvement. (Sue, Sue, Neville, & Smith, 2019. p229–230)

A prospective therapist should also take into account that what is considered to be “normal” or socially acceptable in one culture could be viewed in a negative light in another. One needs to take the time to also make sure that the forms of care being provided aren’t simply a repackaging of the ideas of settler colonialism that have already been placed upon Indigenous communities and practices (Hodge, Limb, & Cross, 2009, p212–213). It is necessary to remember that those coming in for care might already have experienced trauma at the hands of the settler state and further pushing to adopt methods of care that do not work within their culture can compound the trauma already there.

Within Western psychology there is the idea that if one’s emotional and logical selves can work in harmony, then they will have what is termed the “wise mind” that is able to work in such a way that is socially and culturally acceptable. A person who has been treated through psychological treatment and is viewed as having been cured (or trained in how to mask their symptoms) is often viewed as someone with a “whole mind” or a “healthy mind” insofar as the person is able to interact with those around them, is relatively free of intrusive thoughts, even if they are still struggling with their conditions in the background. I ask that you think back to my story at the beginning of this letter, how I’d been taught how to hide or mask my experiences and how I saw the world so as to be deemed acceptable by the larger society around me. I was never cured, even when medication was introduced to control symptoms; I simply had learned how to act and perform certain actions that were considered to be those of a normal person.

This can also be seen in the treatment of autistic people through ABA or Applied Behavioral Analysis therapy, something that many autistics state is akin to torture.

While allistic people view autistic people behaving and acting in a “socially acceptable” way, the truth is that autistics are simply being taught how to hide who they are and pretend to be a certain way that people want them to be. But the cost of this socially acceptable presentation is often through fear, punishment, and sometimes physical abuse (Lynch, 2019). The idea is that the autistic person can be cured of their mental illness, despite the fact that there is no actual cure. Instead of helping the autistic person learn how to move around in a safe way in an allistic world while still giving them space to be who they are and experience the world in their own way, they are forced to conform to the allistic standards set forth within their culture.

I bring up this example because this is unfortunately also how many forms of therapy and mental healthcare are performed. Instead of helping the person find a balance and work within themselves to have a whole or complete self, they are often taught how to hide their symptoms in the name of curing them of a mental illness as if their mental condition were similar to a cold or a flu. When we contrast this to the idea of the Native Model of Wellness, we can see that the focus is no longer on curing a specific condition, but in bringing all aspects of a person’s self into balance (Hodge, Limb, & Cross, 2009, p213–214). At the center of the model is the spirit, an aspect often left out in Western psychology unless the provider themselves has a strong spirituality that they tie into their work. For most cases though, religion, spirituality, and metaphysical belief are left to the side and the focus tries to keep within that which can be readily studied and proven through scientific experiment. Beyond the concept of spirit, body, and mind being tied together, is the concept that no single person exists on their own. We are all part of a family, a community, a culture, and a history (Hodge, Limb, & Cross, 2009, p214) and all of these aspects play into who we are and how we experience the world.

The primary focus within Native American Psychology is that of balance. If one area of one’s life is out of balance, it will affect the other areas and create what is deemed to be sickness. “Health and well-being are the result of the complex interplay among our spirituality, physical status, cognitive and emotional process, and environments” (Hodge, Limb, & Cross, 2009, p215) meaning that to be healthy, we need to focus on all areas and not just trying to fix or cure a single area. This concept is often presented through the idea of the medicine wheel, with each of the four segments (Spirit, Body, Context, and Mind) representing an aspect of the whole person. All aspects are tied together, with the goal being a harmony, not a curing or fixing, of all aspects of the person’s being.

For example, if a person hears voices, but those voices are not causing harm nor interfering with their life, then is it something that needs to be fixed, or is it simply an aspect of who they are that is in balance with the rest of their being? Just because a person experiences the world differently than what is deemed by Western culture to be acceptable or normal doesn’t make them sick any more than a person having a different eye color than the majority. It is only when those experiences or aspects become detrimental or fall out of balance that care becomes needed. But even then, the focus should not be to cure them of how they experience the world and to force them to experience it in the same way as is deemed acceptable, but instead to help them find a balance within themselves and those around them.

This method of care moves in direct contrast to the standard methods of practice of Western psychology, and yet it also works towards the supposed same end goal: the individual being whole or healthy. The key difference is that one method seeks curing the person, while the other seeks balance. It would be similar to working with someone who has a physical condition that is considered incurable; do you continue trying to fix them so that they can look/act/be the same as someone without that condition, or do you work to help them live their life as best as they can even with the condition? We as a culture have moved away from hiding those with disabilities and physical differences to working to help them integrate with the world around them through adaptive technologies, devices, and adaptations to various devices (such as cars).

Why should it be any different with mental health?

Instead of trying to simply “cure” a patient, we should seek to help them find a balance with how they experience the world in such a way that they can not only be whole as a person, but able to thrive. In some cases this might require medication or treatments we’re familiar with in Western medicine, while in other cases it might require looking outward and setting aside the standard procedures we’re taught and looking at the person as a whole being and not just their conditions. I keep calling back to Native American psychology in this section due to the focus of balance and harmony with all aspects of a person’s being rather than just the socially acceptable areas. This means working with areas that we might find strange or new to us, and requires that we work with and listen to our patients instead of talking over them. If a patient describes hearing a static around them that isn’t of a physical nature, then we should seek to understand what that static is and not simply hand wave it away as hallucinations. It could be something we have yet to understand in our field of education or within Western science.

We can tie together the holistic or balance view of care with Western psychology, despite on the surface the two modes of care appear direct opposites. Cognitive intervention can still be used for people dealing with emotional disregulation or unproductive thoughts, however instead of using it on its own it should be tied in with other interventions that are either culturally tied to the patient’s culture or methods that work to help balance the disregulation with other areas such as spirituality or structural interventions using one’s family or community ((Hodge, Limb, & Cross, 2009, p216).

The holistic approach to care can also work towards working with generational trauma, a concept that is not often discussed in Western psychology due to the removal of the spiritual or generational beliefs as unproven or unscientific. In some cases historical trauma or generational trauma can be the cause of a person’s core aspects being out of balance. The unsolved disappearance of a family member, or the loss of one’s culture and heritage can readily throw a person out of balance, and unless those areas are dealt with, that person is going to remain out of balance and depending on the culture, could pass that imbalance on to their family or even next of kin (Hummel, 2016).

If we look back to the medicine wheel concept once more, we can also look at the four segments much like seasons, with the inevitable change that will occur over our lives and the need to address these changes in a way that will allow us to remain in balance (Roberts, Harper, Tuttle-Eagle Bull, & Heideman-Provost, 1998, p142). Instead of simply telling ourselves “it will get better if X happens” we can focus on how we could work towards making X happen (a new job, meeting new people, saving money, etc) without bring harm to ourselves or throwing ourselves out of balance. Working towards saving money through cutting out all forms of leisure will get us the money we want, but will cost us our mental or physical health, meaning our methods weren’t healthy methods in working towards our goal. The balance needs to always be addressed, no matter what we do or how things around us change.

While Native American Psychology is not a fix-all for the issues we see in today’s Western or Eurocentric psychology, it is an area where I believe anyone entering the field of psychology should study and look towards when it comes to working with clients from all cultures and walks of life. I do believe that we need more psychologists who are trained to work with Indigenous peoples, and we need far more than 200 providers who themselves are Indigenous in the United States to be available to work with communities and peoples who are currently having to do without despite supposedly having access to that area of care. Those entering the field need to be willing to acknowledge the fact that Western psychology is not “the way” to solve mental health issues, and be willing to challenge their own bias as well as the bias of those who are in positions of power within the education system. Change is necessary at this point, and it will need to come from those of you coming into the field.

Works cited

Benson, E. (2003, June). Psychology in Indian country. Retrieved from https://www.apa.org/monitor/jun03/indian

Gone, J. P. (2004). Mental health services for native americans in the 21st century united states. Professional Psychology: Research and Practice, 35(1), 10–18. doi: 10.1037/0735–7028.35.1.10

Hodge, D. R., Limb, G. E., & Cross, T. L. (2009). Moving from colonization toward balance and harmony: a native american perspective on wellness. Social Work, 54(3), 211–219. doi: 10.1093/sw/54.3.211

Hummel, B. (2016, July 12). Historical trauma: the confluence of mental health and history in native american communities. Retrieved from https://medium.com/@bradyhummel/historical-trauma-the-confluence-of-mental-health-and-history-in-native-american-communities-5513985836c5

Lynch, C. L. (2019, November 1). Invisible Abuse: ABA and the things only autistic people can see NeuroClastic. Retrieved from https://neuroclastic.com/2019/03/28/invisible-abuse-aba-and-the-things-only-autistic-people-can-see/

MacMillan, A. (2017, February 23). Why mental illness can fuel physical disease. Retrieved from https://time.com/4679492/depression-anxiety-chronic-disease/

Roberts, R. L., Harper, R., Tuttle-Eagle Bull, D., & Heideman-Provost, L. (1998). The native american medicine wheel and individual psychology: common themes. The Journal of Individual Psychology, 54(1), 135–145. Retrieved from https://psycnet.apa.org/record/2000-00195-010

Robertson, D. L. (2013, September 20). Playing ‘Indian’ and Color-Blind Racism. Retrieved from https://indiancountrytoday.com/archive/playing-indian-and-color-blind-racism-S_1F5NbyF060preacKUG3g

Sue, D. W., Sue, D., Neville, H. A., & Smith, L. L. (2019). Counseling the culturally diverse: theory and practice. Hoboken, NJ: John Wiley et Sons, Inc.

Williams, M. (2013, June 30). How therapists drive away minority clients. Retrieved from https://www.psychologytoday.com/us/blog/culturally-speaking/201306/how-therapists-drive-away-minority-clients

Wood, P., Burwell, J., & Rawlett, K. (2018, October 10). New study reveals lack of access as root cause for mental health crisis in america. Retrieved from https://www.thenationalcouncil.org/press-releases/new-study-reveals-lack-of-access-as-root-cause-for-mental-health-crisis-in-america/

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Trans masc author of “The Guardian’s Ascension” and owner of Illuminatus Design. Media inquiries: TheMicheaB (at) gmail (dot) com

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