Anne Zimmerman
Welcome to the Voices in Bioethics podcast. I’m Anne Zimmerman and today our guest is David Edward Walker. He holds a PhD in psychology and had many years of experience in the US Indian Health Service as a licensed psychologist. His book, Coyote’s Swing, a memoir and critique of mental hygiene in Native America chronicles his experiences of cultural immersion in the Yakama Nation and provides a strong critique of the mental health and mental hygiene paradigm. Welcome to the podcast.
David Edward Walker
Thank you, Anne, for inviting me to visit you and your listeners.
Anne Zimmerman
Thanks. So let’s start by helping our listeners kind of understand your experience. It’s really unique because you had the opportunity to become very much a part of the Native American community that you served. Who are the Yakama people and how did they come to accept you and value your counsel? And could you touch on what you sort of did to earn their trust? Or how that came to be?
David Edward Walker
Well this is a magnificent question to begin with and that I will just say, begin by saying, the people of Yakama Nation are a community of over 10,000 members of descendants from among numerous original people inhabiting the lands from the Columbia River plateau down to the Columbia River basin itself or Nch’í Wána and have been inhabiting that area at the time of European colonization in the 1850s. They have a treaty, the Treaty of 1855, that signaled an end to three years of war to defend their land which they’ve held as sacred for more than 13,000 years or as native people often put it since time immemorial and with this treaty numerous family bands were compelled by US authorities and European settlers onto a reservation of about 2200 square miles in central Washington state and that’s where I worked for about 22 years.
So let me, yeah, I should probably say something about the word Yakama because the etymology of that word is uncertainty. It was imposed within the treaty and I contend in order to avoid, this was done to avoid further land claims. Yakama is not a place name and you find that the actual names of bands and families such as Wenatshapam or Kah-milt-pah refer to specific places identified with where these original people lived, hunted, and fished. They were nomadic and so you see right away this word Yakama kind of puts people in a place in the predicament of a reservation setting and that’s by virtue of trying to keep that name in the treaty it keeps them from making further claims to other lands. So if I if I think about being accepted I really can only answer obviously from what I experienced it’s true I was invited to participate in many traditional events and ceremonies at Yakama Nation. I was also taken under the wing of numerous elders and befriended and honored by their teaching but to say that I became part of this community could suggest that I was somehow formally adopted by it and that never happened. I think it’s better to say I was invited to learn to be a helper in this community and this meant, kind of entailed, being reeducated as a human being. To be called an uncle by some family members became a great honor for me because to be a helper also meant being a relative, but I’ve always been the uncle from somewhere else at Yakama Nation and that’s an important distinction that I should make and that I’ve always kept front of mind.
Anne Zimmerman
And how did they come to trust you or did they come to trust you?
David Edward Walker
Oh, sure! I think that I’ve earned the trust of quite a number of people at Yakama Nation. I would probably say that that came from the perspective that I held when I first arrived there. I had retreated from the threat of insurance company managed care to psychotherapist into working for about four years as what might be called a clinically informed organizational psychologist. From that point I entered a personal spiritual crisis due to a serious medical situation in my family and a series of events brought me to Yakama Nation after I worked internationally and had quite a fair amount of intercultural work as well as an organizational psychologist. So I was kind of returning to clinical work as a result of a personal search and ended up coming into the Yakama position with the Yakama Indian Health Service. I’m very much like an international sort of representative. I felt I was moving into a sovereign nation, okay? I took the perspective that I needed to maintain a stance of paying a lot of attention to my own personal behavior and decorum as I entered the land that belonged to someone else. So I I really feel that that what helped me was humility and kind of questioning whether I really even had theories or techniques in my training that could be helpful to people of such a different culture. So I was coming from a particular philosophical position inside myself, which we might summarize as being phenomenalist and moral constructivist, and I felt entirely dependent upon Yakama people to teach me in what ways I might be useful through consultation and collaboration.
I have a little story from the beginning of that that I could share about kind of getting oriented, okay? I received by the way no orientation whatsoever from the Indian Health Service. I didn’t know anything about Yakama people and probably one of the earliest experiences I have that I can recollect was about the importance of giving in Yakama culture. My children had many extra toys when we arrived that they decided to donate as we went through the moving process and I dropped them off at the Yakama Nation Head Start program one morning and when I arrived at the clinic only 10 minutes later, our medical receptionist, our Yakama medical receptionist, winked at me and said she’d heard about my family’s gift. And so by this I realized the speed of what she referred to as the moccasin telegraph and she was very amused by my total amazement that she already knew about this and this was interesting because I was being taught about the power of giving. I will mention I learned much more about that through my kala which means adopted grandma, it’s just actually Yakama slang. Levina Kussamwhy Wilkins, who I always like to mention, she’s a revered elder of the Wenatchi band of Yakama people and she did me the honor of teaching me as she’s taught many people. She would refer to a word in her language, or a phrase, pina ɨwaat ku kw’ałáni. These words express the nature of leadership in referring to a willingness to give everything one possesses for the sake of the betterment of others. So our family had unwittingly behaved in accord with that teaching and donating the toys and that’s how it came to be viewed in a favorable light. So this also alerted me to how powerful the ways already were in my presence and that I was in a position of learning rather than teaching or coming in with something specific or particular to offer.
Anne Zimmerman
So then Indian Health Service is really an agency within the Department of Health and Human Services and that’s really responsible for providing federal health services to Native Americans and it really is tasked with improving Native American. Health how did you really become involved with the IHS and does the IHS understand that need to be culturally competent that you kind of stumbled on understanding right at the beginning of your tenure?
David Edward Walker
Well, I think that broadly speaking if you look at the various publications and manuals and policies of the Indian Health Service certainly there’s recognition of the need for cultural competence, so-called cultural competence, and this sort of thing. The operationalizing of that, the actual enacting of that, I would seriously question. I was brought, frankly, to my position at the Indian Health Service through a confluence of events and extraordinarily powerful synchronicities in my life which are detailed in the book. I will just summarize it by saying that I was pretty unhappy and grieving and I ended up meditating in a Buddhist way and one night I was actively praying for assistance. To be of service more directly with human suffering. The very next day a client was finishing up our work together and she spontaneously asked me what would I be doing after she moved on, which was unusual question, then I pause and just asked why do you ask? She said very directly I think you should work with Native American people. I think you should be working in Indian country. She then invited me to a conference on Wellness, Indian Wellness, in Scottsdale AZ and the rest of that story is really detailed in the book, but the confluence of my prayer and her spontaneous counsel to me, really advising me, and going to this conference really set the stage for me to accept a job with the Indian Health Service. I really didn’t know anything about the Indian Health Service at that point.
Anne Zimmerman
So you mentioned that you were really looking to help people who were suffering. The Native American community does have a lot of human suffering and you note in your book that IHS is really steeped in psychological terminology using the language of psychology and psychiatry. Is the terminology problematic and part of what maybe allows people to fail to understand the real on the ground circumstances in these communities?
David Edward Walker
I think so. I think also we should always still bear in mind that there’s always been, or I shouldn’t say always been but there has been historically many efforts to destroy indigenous languages and so the terminology itself becomes an imposition from outside of communities as a substitute for actual cultural experience. A person is being invited or perhaps actually compelled into a situation where they accept a psychiatric or psychological label or formulation about themselves that is foreign to their traditional ways, foreign to their history and certainly foreign to their experience of oppression. Back in the 1960s a sociolinguist named Basil Bernstein coined the term restricted code to describe language that’s used to solidify the boundaries around a class of people, whether they be working class or be professional class. I’d use psychiatric and psychological terminology when it moves across cultures and especially when it moves into Indian country as a restricted code, okay? It actually helps a particular elite to have a unique language to talk amongst themselves and to obscure their intentions and what they’re all about to people they serve, okay? They have to then explain to the lay, now lay public certainly talks about, uses the same terms, okay, in their everyday dialogues or what are you on bipolar whatever what are you on ADHD.
But the thing is that they lack the authority granted by the state to make the term stick, okay? So what we do then is we anoint a certain class of people in our society who are given the role of using that terminology in an authoritative and sometimes authoritarian way that I think is extremely problematic moving across cultures. So I’ve moved from the idea of what I’m calling a restricted code that like Basil Bernstein did. I’ve been quite moved by my conversations with my friend and colleague, Steven Newcomb, who is Shawnee-Lenape, and we’ve had many talks about doctrine of discovery and his documentary and his book of Pagans in the Promised Land, in which he works with looking at tribal law and federal government and tribal law and the influence of Christianity and Christian notions of domination and tribal law is interpreted by the federal government. And he’s called that a domination code I take that domination code and I bring that into the mental health world. So that’s why I say that that language is very problematic and potentially oppressive.
Anne Zimmerman
Issues that require sort of a critical approach to psychology and psychiatry are really more substantive than just the terminology but terminology is sort of a big part of it but people come to see themselves as fitting into these definitions for, they see themselves as having disorders. How would you really describe the mental health that hygiene paradigm and how it operates in the HIS?
David Edward Walker
Well the IHS evolved out of military medicine in Native America, which you know is kind of a common sense that that would happen because this was an occupied people in many places in the US and then so military doctors became involved in their care and then treaty entitlements, I should say treaty rights is more accurate, treaty rights, those rights guaranteed as supreme law of the land, Article 6 of the US Constitution, really dictated to the government that that provision of healthcare had to be codified and formed into agencies of provision which initially were the US Public Health Service out of which the Indian Health Service was formed in the 1950s. The Indian Health Service not having existed prior to them, there was a mental hygiene movement that stretches all the way back till shortly after the Civil War in Indian country, which I trace in my book. Today, as back then and frankly, a Western biomedical model of mental health, behavioral health, that very much correlates very closely with how things are how that view is dominant in American Society is pervaded by the US Indian Health Service so it’s not very different as far as how it operates and how it’s enacted in in Indian country. And that was a shock to me when I first arrived at IHS.
Frankly I got into a lot of trouble just asking questions about how these things were done and the belief systems involved. But over time I had to decide really not to try to rehabilitate my employer because I was just getting into too much trouble and so this stimulated my own research into the the sordid tale of the Euro-American mental health movements entry into Indian country because I was very really very curious about that if you think about emphasis that we placed on intergenerational trauma, historical trauma, and these these phenomena in marginalized communities, okay? We can also ask questions about the intergenerational heritage of perpetration, okay, and what are the systems what are those systems of socialization of professionals and other people coming from outside these communities as they approach this community and that’s very interested in that I wanted to know who are my professional ancestors, okay? So that’s basically what started my first research into the book and oppression is something you a few minutes ago and you mentioned in your book.
Anne Zimmerman
And oppression is something you mentioned a few minutes ago and you mention in your book. And oppression is a term that we use a lot in discussing Native American circumstances generally and some characterize oppression as a social or economic determinant of health or determinant of mental health, increasing the odds of depression and mental health problems, and that sort of medicalizes this idea of oppression. Do you think that growing up oppressed has sort of been mistaken for depression and that the oppression itself is being medicalized?
David Edward Walker
Well you know I’m quite aware that for some people including scholars that I’m moving against the grain of opinion, that being oppressed is depressing and therefore we should just say people reacting to oppressed experience should be so labeled with major depression or bipolar or PTSD or ADHD or whatever. These labels to me are themselves cultural impositions in a form of indoctrination. I consider them as kind of thinking a sort of circular sort of tautological shibboleth, if you will, you know one culture establishes itself by conquest and colonization using assault and violence and then creates a system for troubled or troubling citizens whereby they are frankly othered and medicalized on behalf of their lack of optimism or productivity or conformity and that to me in itself is a dubious enterprise, okay, but when that same system gets applied to explain the individual reactions of original people, redefining them as disturbed or disordered and then avoiding looking at it all perpetration is the cause of their struggles and distress, I feel oppression is simply made invisible, okay, so I think that actually the mental health system serves the invisibility of oppression and I take the stance that it needs to be deconstructed and taken apart for those reasons especially in its terminology and labeling.
Anne Zimmerman
And then when you take that terminology and labeling, there is another aspect that I think we really want to discuss which is actual use of medication. So in these Native American communities where the IHS is giving the healthcare and the mental healthcare, who’s prescribing medicines for mental issues and what are those conditions? What are they really treating? Might they just be speaking to that invisibility of oppression that you mentioned?
David Edward Walker
Well, I think they are. And it is kind of, I have to give you kind of a complex answer and talk for just a minute about that because therein lies the rubbish, as we say. I’ll mention first the patient healthcare questionnaire 9, the PHQ 9, which you may have heard of, which is actually used widely across the US healthcare system as a short form screening tool for depression. My primary care provider gives it to me every time I go to the office and I always put a big X through it because it’s actually a Pfizer product. It was developed in the 1990s by the pharmaceutical giant Pfizer corporation in partnership with psychiatrist Robert Spitzer and associates who helped develop the DSM as well, and Pfizer just simply saw a really good opportunity in marketing its products by releasing ownership of its copyright which is really a brilliant move frankly. So these days you just see the PHQ 9 everywhere and this is a tool where you fill it out and many people may already be familiar with it asks if you’re discouraged, unhappy, how you’re sleeping, whether you’re irritable, these sorts of things, and then your doctor or nurse has been really specifically trained to offer you psychiatric drugs as a solution, so this brings us to the Indian Health Service where as a matter of policy the PHQ is offered as a something that people need to be screened with, Native people need to be screened with whenever they come into an IHS clinic or IHS funded grant funded tribal clinic, okay, which are somewhat different but they still have the same basic manuals and and policies. So the PHQ 9 is being widely used to diagnose and label native people with major depression throughout the Indian Health Service system and it emphasizes psychiatric drugs through its primary care doctors. There are psychiatrists at Indian Health Service and psychiatric nurses but most of the medication likely flows through primary care doctors at these clinics. IHS also has in-house, its own official policies regarding best practices, best clinical practices that psychiatric drugs should be tried as a first approach, so that’s going to be the first emphasis. So the amount of prescribing and proliferation of psychiatric drugs within Native communities through IHS is pretty much unknown. That’s because the agency is not really held responsible for telling or presenting that kind of information to the public. Many native people have no other place to go for their healthcare and they may not be aware of the many hazardous side effects of the drugs themselves.
Anne Zimmerman
So one follow-up question I have in this area is are the conflicts of interest different in IHS or is the problem just the same but there is a financial incentive to medicate people for these disorders and that incentive it exists everywhere any market, that a drug company could sort of expand into would be favorable profit wise or is there something different? Are people being preyed upon here?
David Edward Walker
There is no financial incentive for Indian Health Service providers to offer psychiatric drugs. They’re paid on salary. They’re government employees. The clinics, the tribal healthcare facilities, are deeply underfunded. There’s been two congressional investigations of the Indian Health Service that have found a great deal of mismanagement and corruption in the Indian Health Service as an agency. So we have two problems. We have underfunding and we have mismanagement and corruption within the agency, okay, that have been identified, by the way, through the auspices of a Democratic senator and a Republican senator. One of the few things that people seem to be able to agree about in Congress, okay? So we have these two phenomena going on that face people so if we take the underfunding, okay, and we think in terms of medication the provision of which is fairly easy to just offer a prescription and you’re you’re very short on resources otherwise and your own clinical manual says that’s the best first practice then the way that you understand and respond to major depression and parentheses reactions to oppression is by providing psychiatric drugs.
So we have also simultaneously, Native people have the highest rate of suicide of any ethnicity in US society, and we can look to what is now well established research finding that antidepressants in particular increase the propensity of suicidal behavior by as much as 2.7 times that of the general population. When we look at other data like 10% of suicidal deaths by overdose in Indian country occur through the ingestion of psychiatric drugs themselves, having the drugs being administered to communities with high suicide rates and even being adjusted as a method of suicide, I feel this kind of information needs to be looked at much more closely. One of the things that really blew my mind and I couldn’t include in Coyote’s Swing was discovering some more data, after I’d written the book, about unintentional overdose in Native communities. Many researchers in suicide feel that unintentional overdoses likely mask a sizable number of undetected suicides and we also are seeing through SAMHSA, of all places, the US Substance Abuse and Mental Health Services Agency, illicit abuse of psychiatric drugs in Native communities to be second only to cannabis abuse, which is amazing to me when you think of the emphasis on methamphetamine, which is a problem, a scourge in some communities, okay, illicit abuse of psychiatric drugs is three times the rate of methamphetamine abuse. So that was something I didn’t have I couldn’t pull that little kernel of truth into Coyote’s Swing I just definitely want to announce it here on your podcast because that’s just amazing to me. Simultaneously we have a huge surge in psychostimulant abuse among young adults in in Native communities in Indian country so these kinds of phenomena are happening but they’re not getting much attention and that’s something that I think needs to change.
Anne Zimmerman
And do you think the availability of these drugs is similar across Native American communities as it is elsewhere in our country? Is it easy to get everything from prescriptions to drugs that are sold in more of an underground market?
David Edward Walker
I don’t know because that is not being sufficiently researched. We don’t get the detail of the drill down to specific communities very readily, we get these sort of large frame studies across multiple systems. It’s just not really known. I will tell you this, just anecdotally, that when I was on the reservation 20 years ago working full time. I knew that a lot of Ritalin and Dexedrine was flowing out of our clinic and I was working predominantly with youth and learning about the cottage industry that had emerged on the reservation where you could get four hits for Ritalin for 10 bucks in some of the housing projects. That was back then. That was 20 years ago.
Anne Zimmerman
Sounds like private school in New York.
David Edward Walker
There you go. Yeah, so , I did also did a little research in house when I was at IHS trying to figure that out and I noted that some families the entire family had been diagnosed with ADHD, and I knew that some of these families were notable suppliers to the community for illicit psychostimulants. You can imagine the hair on the back of my neck sticking up and trying to raise those issues and memos which would get me in a lot of trouble.
Anne Zimmerman
And how would you describe the economic opportunity of the people growing up in the Native American communities, in the Yakama nation specifically? Did you feel they had good economic opportunities?
David Edward Walker
I think it’s an excellent question but we need to kind of define what is economic opportunity, right? I mean it’s you know if you think of it more sort of commonly held sort of definitions of that it’s fairly bleak. We could say that you know up to 80 percent of Yakama people of eligible for employment are unemployed. That changes somewhat seasonally because Yakama Valley is a very rich agricultural area and so there’s more migrant labor and seasonal labor available at specific times of years. But it also masks another phenomena which is how do people cope with that level of poverty and unemployment, okay? So you will often have in some of the housing project areas, the HUD housing projects, that go back many years. You’ll have one or two full time income earners supporting quite a number of people who are doing a variety of other things. Perhaps they are fishing, hunting, making and selling crafts. Perhaps they’re doing other different things that have to do with hustling tobacco which you can get for cheap on Indian Reservation because the taxes aren’t there. So there’s all sorts of different things going on whereby people cope, okay, with that level of poverty, but as far as economic opportunity it’s in conventional sense it’s fairly bleak.
Anne Zimmerman
So how did you feel the social conditions affect their emotional state?
David Edward Walker
Well I can think of working with a Native grandmother who was taking care of four or five children from different families on Social Security disability and who came in one day to present me with a baggie full of wild huckleberries she picked in the mountains. And this was of course a tremendously humbling moment for me because, I mean, I still get a lump in my throat when I think about this, because her culture and her way of living, her way of being a human being was so strong and teaching me about her life, what could I possibly offer from the standpoint of a psychotherapeutic intervention? Who was receiving the intervention in that moment? So I’ve always been one to like see what people are up against, okay, and recognize the strength of their ability to adapt resiliently and move through, sometimes transcend that, but as far as how oppression affects them, I think people get extremely discouraged and disheartened and political, social, racist, discriminatory, persecutory type events, deeply affect their daily lives and they are certainly not unaware of it. But do I call that major depression? No. I see it as very significant problems in in living as a human being.
Anne Zimmerman
But it seems like they have really strong community ties and a strong sense of cultural traditions like picking the berries and you know just being so pleased with your initial welcome gift. I think we sometimes perhaps focus too much on economic opportunity and have some anticipated depression that really communities could probably overcome some of the unhappy aspects by sticking with some of their strong community traditions and instead it seems like a lot of the psychological labeling has turned into these stereotypes. How do you think those stereotypes affect young Native Americans that sort of result from the mental health paradigm where they are labeled?
David Edward Walker
Well let me just preface that by just adding a little addendum on to what we were just talking about and I’ll just say that there’s kind of an amalgam going on. You know, I could paint the employment picture as as bleak but I can also mention there’s a casino at Yakama Nation, many people work there. There’s also a college, a small college and university called Heritage College, people go to school there. In the immediate vicinity there’s not a lot of jobs for people who don’t take those avenues and we have a very high dropout rate in high school in Yakama Valley and so when we look at the dropout we can start looking at what’s affecting kids in the schools, okay? One of the things that affects them of course is racist stereotypes that they have to deal with, okay? In particular the stereotype of the dumb Indian, okay, the dumb Indian is a creation of psychology itself. We go back in the history of perpetration by the mental health movement we can see many psychologists coming into research what was already predetermined to be inferior Indian intelligence in American Indian boarding schools using highly biased paper pencil tests and reporting their results which showed Indian kids to be less intelligent than white kids or other kids, okay, and therefore the curricula in the American Indian boarding schools was tilted towards domestic or manual labor.
So generation several generations from 1890 to 1970 grew up with that kind of belief system being imposed upon them and then we have that internalized and then people teaching their own kids don’t aim too high and this is something my kala Elena talks a lot about. She’s a well-educated person and an extremely traditional Yakama person. She’s very forthright in saying there’s nothing wrong with our Native minds, our minds are a gift of the Creator and they are highly intelligent and highly able, okay, but there’s a contamination that comes from the stereotype of the dumb Indian. That contamination comes from the history of psychology, a field that hasn’t you know maybe acknowledged and apologized for its history of perpetration in this way but has never detailed it. Never bothered to bring it down to the street and say this is what we did. So are we then in Indian country as mental health providers from outside of Native communities treating that which we inflicted years ago, so that kids drop out prematurely, their schools are underfunded, under resourced, their culture is, you know, made invisible, and they leave school.
Anne Zimmerman
So to bring that question back to tying it to that mental health paradigm being labeled with certain disorders, depression, anxiety, and that type of thing, generally, and perhaps, not just in in the Native American community, there’s a lot of popular acceptance of the criteria in the DSM- 5 and there’s always, it seems for some time there’s been a lot of acceptance of psychiatry and these labeling of disorders the diagnosing. Why do you think that that is also acceptable, and do you think that the in the IHS the people in those communities just feel sort of stuck with this paradigm that outsiders inflicted?
David Edward Walker
Great questions! I’m breaking it down a little bit here you know if we just go from a pragmatic standpoint, much of the funding for Indian Health Service comes through congressional appropriation, offsetting the chronic underfunding that the IHS receives, and has received for almost all of its existence, is Medicaid systems. Medicaid dictates the use of DSM or ICD 10 or 11, I don’t know which one we have now, DSM 5 or ICD 10. It dictates the use of those criteria in mental health provision, notwithstanding cultural difference or whatever might be the case of a particular community or its context, that’s the federal methodology that’s dictated from on high. Native people don’t get a vote in that. The Indian Health Service provides their healthcare through federal mandate and through federal funding, and even, will permit Native communities to manage that healthcare through what’s called Public Law 638, that law allows tribes to take over the management of their own healthcare. But in order to receive the grant to manage the healthcare for the community, you must follow the policies and procedures that are predetermined by the federal government. So, you do see some traditional healing and some you know sorts of ideas about culture and tradition being brought into Indian Health Service. However, is any of that Medicaid billable? Is any of that something that’s going to add to the coffers of a completely underfunded system, so there’s not an emphasis on that and indeed instead there’s an emphasis on the biomedical view of mental health that dominates our entire society right now. So, that’s part and parcel of what really goes on as far as control and I think that has to change.
Anne Zimmerman
And you mentioned some solutions in your book. You highlight the benefits of traditional healing and some ways of life, and you know that a lot of the old ways were themselves working, and that the mainstream mental health paradigm is sort of a negative disruptor in these communities, rather than a beneficial addition to the Native American communities. What do you recommend from here?
David Edward Walker
Well, you know, I wouldn’t, I don’t think it’s even my place to say that there’s nothing of benefit in the US mental health system for native people. I think that’d be pretty outrageous for me to say something like that. What is or may be a benefit to Native people in the US mental health system is for them to determine, and I believe because they’re sovereign Indian Nations or enrolled in consisting of enrolled membership and their own governance, they should be the ones to decide. So the way that that would happen, that not currently existing, would be through a deconstruction of the entire system and that would occur by freeing up the funds that are currently controlled by the federal government and giving charge of those funds to Native nations themselves and also simultaneously instituting some sort of process whereby people can circle together. I really have a strong feeling for traditional talking circles I’ve been a part of they’ve always been fantastic, and because they equalize the people who are involved in a circle, everybody’s at the same level, everybody can see one another and to have an opportunity to really revision mental health together and to see, find out, what is needed and what’s of use and what’s not and to move from there. So by incorporating and really putting in the lead Native people and their traditions for healing, so that they get to choose, they get to decide about all that.
Anne Zimmerman
And, lastly, in your own notes from a 2019 event that was called Revisioning Mental Health, you suggest that your profession, psychology, is not necessarily honorable. I think it’s kind of a strong statement and you had it in a little note toward the end of the book. What would make the practice or field of psychology, and psychiatry, what would make them more ethical or improve their ability to be more consistently honorable, rather than something dishonorable that you note?
David Edward Walker
Well you you found that, I think you looked at that from a statement that I made when I was kind of summarizing my profound experience at the Revisioning Mental Health event that we had in Minnesota, which was inspired by Deena Metzger, the feminist writer and counselor, and a woman Laura Matz, who had, was a psychiatric survivor and that that event was very profound. At the time I was actually working on trying to understand what is cultural competence and I’ve since kind of given up. I think it’s just, there’s so many problems in the concept, we don’t really have cultural competence yet anywhere. But at that time, I was looking into kind of developing a mnemonic that had as its letters honorable and so I was thinking, that’s what was in my head, as I said oh I don’t think my profession is honorable. Really considering what has been done in his past, what continues to be done in its present. I think that applied psychology and psychiatry and allied clinical social work, all these fields in mental health counseling, have a long way to go to become honorable, in particular to Native people. That doesn’t mean, by the way, that there aren’t many helpful people and many people who are highly valued and treasured who are working in these systems. It’s just to say that writ large systemically, writ large as fields, okay, there’s been a lot of damage done, a lot of complicitness, that has not been publicly really brought out in a truthful way, so that people can reconcile themselves to what’s happened and what’s been done and begin to deconstruct these systems and reconstitute them in new ways, that will be of better service and will frankly do no harm. So that’s where I’m coming from on that, and until that happens, we’re not really behaving in an honorable way.
Anne Zimmerman
So, do you think transparency would be perhaps a lot more valuable than trying to engage in cultural competency?
David Edward Walker
Yes, well, transparency involves, number one, being truthful as to what’s happened, what’s gone down. I was able to trace a very sordid tale of the mental health system back to the 1870s and it’s not a pretty picture. I see people, I see for example American Psychological Association just came out with an apology to original people of the United States, which is laudable, but what are they talking about? What did they do? We don’t see a really public accounting of what are we talking about here, what happened and what do you continue to do, what do you continue to sponsor? Americans Psychiatric Association in it’s deliberations, maybe two or three years ago, mentioned, had some sort of history track in which they mentioned the Hiawatha Asylum for insane Indians, which closed in scandal in 1933 with the observation that most of the people in in house held from the rest of their life spans were sane quote unquote, and this included children, perhaps incorrigible children quote unquote, coming from the American Indian boarding schools. Children being held in an insane asylum. What did the American Psychiatric Association say? Well at one time we had a place called Hiawatha Asylum for insane Indians and that was one of the things we did early on with Indian people in Indian country. Wait a minute! What was done there? These apologies are great, but they become meaningless if we don’t talk about what’s happened. So, this is where I’m coming from, is that a public account, I look at other places in the world truth and reconciliation. Truth and reconciliation. Then we can move on. I also think there’s a third ingredient, which is kind of this deconstructing and reconstituting in a collaborative way. Okay, and that’s ground up, that’s from working as equals in partnership with other people, across intercultural lines and that in that regard. So anyway I can kind of go on with this. I feel passionate about it. But yeah, definitely, definitely. Those are some of the things that could happen but haven’t really quite happened yet.
Anne Zimmerman
I also noticed that there was a new medical school in a Cherokee community and that people were very excited to think they could become educated within their own community. It’s an osteopathic medical school. I don’t know if there are more examples. I happen to notice that one. Maybe that would help people sort of train among people more like them and learn from people with similar experiences.
David Edward Walker
Well we have our osteopathic school that is open, not too long ago, about a decade ago in Yakima, City of Yakima, north of the reservation. The university, Heritage University, which used to be Heritage College is right on Yakama Nation land and was founded with the intention, is very difficult for some families needing the help of the labor of their children to send them off to school and they can’t afford to do so. So this actually helps with that kind of issue. What is really great for me, is to see Native people themselves taking positions as teachers and professors in in those environments and becoming people who are educating within their community. Yeah, there’s lots of hopeful things that we can see. So my job, you know, I was just talking to my kala (at 40:57) little while ago and I was mentioning I’m kind of an earthworm. I feel that I’m supposed to like dig up the soil a little bit maybe new things would be planted. So I just try to do that part of the job.
Anne Zimmerman
Yes, sure. And we could leave it on that hopeful note. Thanks for joining us today.
David Edward Walker
Oh, it’s been a great privilege. Thank you so much for having me and many thanks to your listeners as well.
Anne Zimmerman
I’m Anne Zimmerman and this has been the Voices in Bioethics podcast with David Edward Walker, author of Coyote’s Swing. Thank you.