Historical Trauma And Unresolved Grief
Historical Trauma and Unresolved Grief:Implications for Clinical Research andPractice with Indigenous Peoplesof the AmericasMaria Yellow Horse Brave Heart, PhDAssociate Professor of Psychiatry/Director,Native American & Disparities ResearchCenter for Rural & Community Behavioral Healthmbraveheart@salud.unm.edu Maria Yellow Horse Brave Heart, PhD
Omniciye Woiyaksape: Sharing WisdomCouncil ProjectIt is our way to mourn for one year when one of ourrelations enters the Spirit World. Tradition is to wearblack while mourning our lost one, tradition is not tobe happy, not to sing and dance and enjoy life’sbeauty during mourning time. Tradition is to sufferwith the remembering of our lost one, and to giveaway much of what we own and to cut our hairshort .Chief Sitting Bull was more than arelation .He represented an entire people: ourfreedom, our way of life -- all that we were. And forone hundred years we as a people have mourned ourgreat leader. Maria Yellow Horse Brave Heart, PhD
Omniciye WoiyaksapeWe have followed tradition in our mourning. Wehave not been happy, have not enjoyed life’s beauty,have not danced or sung as a proud nation. We havesuffered remembering our great Chief and have givenaway much of what was ours . blackness has beenaround us for a hundred years. During this time theheartbeat of our people has been weak, and our lifestyle has deteriorated to a devastating degree. Ourpeople now suffer from the highest rates ofunemployment, poverty, alcoholism, and suicide inthe country.Traditional Hunkpapa Lakota Elders Council (Blackcloud, 1990) Maria Yellow Horse Brave Heart, PhD
Intergenerational Parental TraumaI never bonded with any parental figures in my home.At seven years old, I could be gone for days at a timeand no one would look for me .I’ve never been to aboarding school.all of the abuse we’ve talked abouthappened in my home. If it had happened bystrangers, it wouldn’t have been so bad- the sexualabuse, the neglect. Then, I could blame it all onanother race .And, yes, they [my parents] went toboarding school.A Lakota Parent in Recovery(Brave Heart, 2000, pp. 254-255) Maria Yellow Horse Brave Heart, PhD
Multiple Losses and Trauma Exposure Death of five family members killed in a collision by a drunkdriver on a reservation road One month earlier, death of a diabetic relative Following month, adolescent cousin’s suicide and the death ofanother relative from a heart attack Surviving family members include individuals who aredescendants of massacre survivors & abuse in boardingschools Many community members comment that they feel they arealways in a state of mourning and constantly attendingfunerals. Maria Yellow Horse Brave Heart, PhD
Presentation Overview What is Historical Trauma and Historical UnresolvedGrief? Healing Historical Trauma and Unresolved Grief: TheHTUG Intervention: A Tribal Best Practice Incorporating historical trauma with the DSM IVCultural Formulation in assessment and treatmentplanning Celebration of Survival: The Takini Network Maria Yellow Horse Brave Heart, PhD
The Development of Historical TraumaTheory and Interventions Motivated by desire & commitment to reduce thesuffering of Indigenous Peoples By 1992 – the first Native historical traumaintervention; founded the Takini Network;presentations across the US & Canada 1996 – 2004 - Designed the first Lakota/Nativeparenting curriculum incorporating historical trauma;number of SAMHSA grants 2009 – HTUG selected as a Tribal Best Practice byFirst Nations Behavioral Health Association, PacificSubstance Abuse & Mental Health CollaboratingCouncil, and SAMHSAMaria Yellow Horse Brave Heart, PhD
The Takini NetworkThe Takini (Survivor) Network was formed in1992 to address healing from historicaltrauma and historical unresolved griefamong the Lakota as well as other Nativepeople through therapeutic work,prevention, research, publication andcommunity education. Maria Yellow Horse Brave Heart, PhD
Historical Trauma and Unresolved Grief Historical trauma is cumulative emotional andpsychological wounding over the lifespan andacross generations, emanating from massivegroup trauma (1985-88) Historical unresolved grief accompanies thattrauma(Brave Heart, 1998, 1999, 2000) Maria Yellow Horse Brave Heart, PhD
Historical Trauma Response The historical trauma response (HTR) is aconstellation of features in reaction to massivegroup trauma This response is observed among Lakota andother Native populations, Jewish Holocaustsurvivors and descendants, JapaneseAmerican internment camp survivors anddescendants.(Brave Heart, 1998, 1999, 2000) Maria Yellow Horse Brave Heart, PhD
Historical Trauma Theory and Practice Distortions in presentations about historicaltrauma - it is not about staying stuck in thepast Original intent –to begin a healing process, tomove forward; to reclaim traditional culturalprotective factors; to stop identifyingourselves as victims; to move from identifyingas survivors to transcending and thriving Maria Yellow Horse Brave Heart, PhD
Historical Trauma Theory and Practice Recognizes tribal and regional differences Original HT Intervention developed among theLakota but we humbly respect all tribalcommunities, cultures, and histories Work with different tribes across the US andCanada to tailor work for their tribal groups Approximately 300 workshops/training,presentations across the US and Canada Maria Yellow Horse Brave Heart, PhD
Healing from Historical Trauma &Unresolved Grief Historical Trauma & Unresolved Grief Intervention(HTUG): A Tribal Best Practice Psychoeducation about genocide, boarding schoollosses, & oppression Audiovisual materials about collective trauma Small & large group processing Focus as well on lifespan trauma Grounded in traditional cultural experiences Maria Yellow Horse Brave Heart, PhD
Historical Trauma Intervention: FourMajor Intervention Components Confronting historical trauma and embracingour history Understanding the trauma Releasing our pain Transcending the trauma Maria Yellow Horse Brave Heart, PhD
Confronting the Cumulative, MassiveGroup Trauma Origins of trauma are in genocide Boarding schools compounded trauma Trauma is transferred across generationsthrough impairment of traditional parentingskills, identification, and other complexprocesses; epigenetics research relevant(Yehuda) Children of genocide survivors, children ofboarding school survivors may pass on thetrauma to their descendents Maria Yellow Horse Brave Heart, PhD
Background: Genocide Native history meets UN 1948 Geneva Conventiondefinition of genocide Congressional genocidal policy: no furtherrecognition of their rights to the land over which theyroam; go upon said reservations chose between thispolicy of the government and extermination; wardsof the government, controlled and managed at itsdiscretion BIA Education Division called “Civilization Division” Congressional policy of forced separation ofchildren from family and tribe; militaristic Gender roles and relationships impaired byboarding schools Maria Yellow Horse Brave Heart, PhD
HT, Gender, Parenting Issues Traditional gender roles and relationships impaired –women & children were never the property of men,sacredness of children lost, & men lost traditionalparenting roles as well as roles of warriors andprotectors Many Native men internalized white male values,including the view of women & children as propertydue to forced socialization in boarding schools Parents received messages that our culture wasinferior and we could not raise our own children Maria Yellow Horse Brave Heart, PhD
Relevant Recent HT Publications Brave Heart, M.Y.H., Elkins, J., Tafoya, G., Bird, D., & Salvador (2012).Wicasa Was'aka: Restoring the traditional strength of American Indianmales. American Journal of Public Health, 102 (S2), 177-183. Brave Heart, M.Y.H., Chase, J., Elkins, J., & Altschul, D.B. (2011). Historicaltrauma among Indigenous Peoples of the Americas: Concepts, research,and clinical considerations. Journal of Psychoactive Drugs, 43 (4), 282-290. Brave Heart, M.Y.H. & Deschenie, T. (2006). Resource guide: Historicaltrauma and post-colonial stress in American Indian populations. TribalCollege Journal of American Indian Higher Education, 17 (3), 24-27. Brave Heart, M.Y.H. (2003). The historical trauma response among Nativesand its relationship with substance abuse: A Lakota illustration. Journal ofPsychoactive Drugs, 35(1), 7-13.Maria Yellow Horse Brave Heart, PhD
Other Relevant Publications American Indians had an adult trauma exposure rate of 62.4%to 69.8% to at least one traumatic event; a substantialproportion of these entail death of a loved one (Manson,Beals, Klein, Croy, & AI-SUPERPFP Team, 2005). CG/PG: sadness, separation distress including strongyearnings, longing for and preoccupation with thoughts of thedeceased, and intrusive images, psychic numbness, guilt,extreme difficulty moving on with life, and a sense of the partof the self having died (Boelen & Prigerson, 2007; Shear et al.,2005). CG may also co-occur with PTSD (20-50%); prevalenceunclear for American Indians/Alaska Natives. Historical unresolved grief includes these but also yearning,pining, preoccupation with thoughts of ancestors lost inmassacres, loyalty to ancestors with a focus on their suffering,as if to not suffer is to not honor them, to forget themMaria Yellow Horse Brave Heart, PhD
Prolonged or Complicated Grief Tribes may also be at high risk for CG/PG related tothe impact of genocide across generations andfrequent deaths of attachment figures, due to highmorbidity and mortality rates, & generationalboarding school trauma. Rather than ambivalent relationships, some CGresearchers think that close attachments maypredispose CG development; AI/AN attachmentstyles may be closer and more intense as a culturalnorm Maria Yellow Horse Brave Heart, PhD
Intergenerational Traumatic Grief Federal prohibition against practice of traditionalNative spirituality limited bereavement resulting inunresolved grief across generations Dominant societal view of Natives as “savage” andunfeeling – dehumanizing, invalidating grief Acute grief which persists becomes unresolved,prolonged, complicated Modern multiple losses & cumulative traumaticlosses superimposed upon collective generationaltrauma Maria Yellow Horse Brave Heart, PhD
HT Theory & Symptoms of Depression,PTSD, Prolonged Grief Native mourning resolution is distinct from EuropeanAmerican grief Loss of close relative experienced as loss of part ofself, exhibited by cutting the hair Natives maintain active relationship with ancestorspirits Massive group trauma (genocide) impairs normativegrief; extent & quality of losses (trauma exposure)limit time for culturally congruent mourningresolution; history of prohibition of bereavementceremonies Maria Yellow Horse Brave Heart, PhD
Historical Trauma Response Features Survivor guilt Depression Sometimes PTSDsymptoms Psychic numbing Fixation to trauma Somatic (physical)symptoms Low self-esteem Victim Identity Anger Self-destructivebehavior includingsubstance abuse Suicidal ideation Hypervigilance Intense fear Dissociation Compensatoryfantasies Poor affect (emotion)tolerance Maria Yellow Horse Brave Heart, PhD
Historical Trauma Response Features Death identity –fantasies ofreunification with thedeceased; cheateddeath Preoccupation withtrauma, with death Dreams of massacres,historical traumacontent Loyalty to ancestralsuffering & thedeceased Internalization ofancestral suffering Vitality in own life seenas a betrayal toancestors who sufferedso much Maria Yellow Horse Brave Heart, PhD
Identification & Self-Hatred Identification with the aggressor (A. Freud) &internalized oppression (Freire) Identification with the oppressor’s view ofNatives, resulting in self-hatred Self-destructive behavior (i.e. SA) to avoidpain and to act out the self-hatred Identifying with parents’ trauma responsepatterns Maria Yellow Horse Brave Heart, PhD
HTUG Tribal Best Practice Traditional culture & ceremonies throughoutfacilitated release of emotions Psychoeducation; narratives & trauma testimony Delivered over 4 days; small process groups with thetrained Native facilitators Focus on returning to the sacred path – the strengthsin our traditional culture Ceremonies may help in the healing process,changing brain chemistry, calming traumatic brain Maria Yellow Horse Brave Heart, PhD
Historical Trauma InterventionResearch & Evaluation (1992 - 2003) Reduction in sense of feeling responsible toundo painful historical past Less shame, stigma, anger, sadness Decrease in guilt Increase in joy Improved valuation of true self and of tribe Increased sense of personal power Maria Yellow Horse Brave Heart, PhD
Table 11: Gender Differences for Affects Experienced Often Before, Duringand After the rFemale/MaleAnger70.6%73.3% 41.2% 66.7%Sadness70.6%66.7% 100.0% 80.0% 5.9%33.3%Guilt70.6%53.3% 29.4%33.3% 0.0%13.3%Shame64.7%60.0% 5.9%40.0%13.3%Joy58.8%33.3% 64.7%66.7% 70.6% Maria Yellow Horse Brave Heart, PhD11.8%0.0%26.7%86.7%
Themes from Qualitative Evaluation ofParental Responses (1996-2004) Increased sense of parental competence Increase in use of traditional language Increased communication with own parentsand grandparents about HT Improved relationships with children, parents,grandparents, and extended kinship network Increased pride in being Lakota and valuingown culture, i.e. Seven LawsMaria Yellow Horse Brave Heart, PhD
Culturally Sensitive Diagnosis: the DSM IVCultural FormulationCultural Identity Ethnic or cultural reference group(s) Degree of involvement w/culture of origin & host culture Language abilities, use, & preferenceCultural Explanations of Illness Meaning & perceived severity of symptoms in relation toreference group/s norms Perceived causes & explanatory models that the pt. &reference group(s) use to explain the illness Preferences for sources of care Maria Yellow Horse Brave Heart, PhD
Culturally Sensitive Diagnosis:the DSM IV Cultural FormulationCultural factors related to psychosocial environment & levels offunctioning Culturally relevant interpretations of social stressors, availablesupports, levels of functioning & disability Stresses in the local social environment Role of religion & kin networks in providing emotional,instrumental, & informational supportCultural elements of the relationship between the individualand the clinician Individual differences in culture & social status between theindividual & clinician Problems these differences may cause Maria Yellow Horse Brave Heart, PhD
Culturally Sensitive Diagnosis:the DSM IV Cultural FormulationOverall cultural assessment for diagnosis and care Discussion of how cultural considerations specificallyinfluence comprehensive diagnosis and careReference:Lewis-Fernandez, R. and Diaz, N. The Cultural Formulation: Amethod for assessing cultural factors affecting the clinicalencounter. Psychiatric Quarterly, 2002, 73(4): 271-295. (Table1, p. *********************Examples for Native clients: skin color issues, risk for traumaexposure, traditional mourning practices, racism,unemployment rates, housing availability Maria Yellow Horse Brave Heart, PhD
Cultural Formulation (con’t) Indirect styles of communication, values of noninterference and non-intrusiveness, & polite reservemay delay help-seeking and true presenting problem Variation in eye contact; cultural differences inpersonal space & cross-gender interaction Listening for the meaning in the metaphor Client use of narratives, stories; talking in thedisplacement Beginning phase may be longer Maria Yellow Horse Brave Heart, PhD
Culturally & Historically ResponsiveAssessment Explore generational boarding school history, tribaltraumatic events, and investigate how thesewere/are processed in the family Explore degree of involvement in traditionalIndigenous culture; complexity of culturalresponsiveness is examined in literature onassessment and intervention with Indigenouspopulations (e.g. Brave Heart, 2001 a, b). Use adaptation of the DSM IV Cultural Formulation(Lewis-Fernandez & Diaz, 2002), expanded to includeexploration of boarding school trauma, tribalrelocations, migration, trauma in tribal community oforigin, language Maria Yellow Horse Brave Heart, PhD
Celebration of SurvivalVideo Presentation:A Celebration of Survival: The Takini Network(supported by CSAT)– includes historic boarding school slides– summarizes historical trauma intervention theoryand approach– describes historic 2001 Models for HealingIndigenous Survivors ConferenceFollow up conferences held in 2003 and 2004(CMHS and CSAT funded) Maria Yellow Horse Brave Heart, PhD
Website www.historicaltrauma.com Developed by Raymond Daw (Dine’) Maria Yellow Horse Brave Heart, PhD
References Brave Heart, M.Y.H., DeBruyn, L.M., Crazy Thunder, D.,Rodriguez, B., & Grube, K. (2005). . This is hallowed ground:Native Voices From Ground Zero, In Danieli, Y. & Dingman,R. (Eds) On the Ground After September 11: Mental HealthResponses and Practical Knowledge Gained. New York:Haworth Press.Brave Heart, M.Y.H. (2003) The Historical Trauma ResponseAmong Natives and Its Relationship with Substance Abuse:A Lakota Illustration, Journal of Psychoactive Drugs, 35 (1),7-13.Brave Heart, MYH (1998). The return to the sacred path:Healing the historical trauma response among the Lakota.Smith College Studies in Social Work, 68(3), 287-305 Maria Yellow Horse Brave Heart, PhD
References Brave Heart, M.Y.H. (1999) Oyate Ptayela: Rebuilding the Lakota Nationthrough addressing historical trauma among Lakota parents. Journal ofHuman Behavior and the Social Environment, 2(1/2), 109-126. Brave Heart, M.Y.H. (2000) Wakiksuyapi: Carrying thehistorical trauma of the Lakota. Tulane Studies in SocialWelfare, 21-22, 245-266.Brave Heart, M.Y.H. (2001) Clinical assessment withAmerican Indians. In R.Fong & S. Furuto (Eds), Culturalcompetent social work practice: Practice skills,interventions, and evaluation (pp. 163-177). Reading, MA:Longman Publishers.Brave Heart, M.Y.H. (2001) Clinical interventions withAmerican Indians. In R. Fong & S. Furuto (Eds). Culturalcompetent social work practice: Practice skills,interventions, and evaluation (pp. 285-298). Reading, MA:Longman Publishers. Maria Yellow Horse Brave Heart, PhD
References Beals, J., Manson, S., Whitesell, N. Spicer, P., Novins, D. & Mitchell, C.(2005). Prevalence of DSM-IV disorders and attendant help-seeking in 2American Indian reservation populations. Archives of GeneralPsychiatry, 162, 99-108.Beristain, C., Paez, D. & Gonzalez, J. (2000). Rituals, social sharing,silence, emotions and collective memory claims in the case of theGuatemalan genocide. Psicothema, 12(Supl.), 117-130.Duran, BM, Sanders, M, Skipper, B, Waitzkin, H, Malcoe, LH, Paine, S, &Yager, J. (2004). Prevalence & correlates of mental disorders amongNative American women in primary care. American Journal of PublicHealth, 94(1), 71-77.Huang, B., Grant, BF., Dawson, DA.,Stinson, FS., Chou, SP, Saha, TD,Goldstein, RB, Smith, S.M. , Ruan, WJ, & Pickering, RP. (2006). Raceethnicity & the prevalence & co-occurrence of Diagnostic and StatisticalManual of Mental Disorders, Fourth Edition, alcohol and drug usedisorders and Axis I and II disorders: United States, 2001 to 2002.Comprehensive Psychiatry, 47, 252-257. Maria Yellow Horse Brave Heart, PhD
References Indian Health Service (2001). Trends in Indian Health 2000-2001.Washington, DC: U.S. Department of Health & Human Services.Legters, L.H. (1988). The American genocide. Policy Studies Journal, 16(4), 768-777.Lewis-Fernandez,
Historical unresolved grief includes these but also yearning, pining, preoccupation with thoughts of ancestors lost in massacres, loyalty to ancestors with a focus on their suffering, as if to not suffer is to not honor them, to forget them Maria Yellow Horse Brave Heart, PhD .
Historical trauma - Cumulative emotional and psychological wounding from massive group trauma across generations, including lifespan Historical trauma response (HTR) is a constellation of features in reaction to massive group trauma, includes . historical unresolved grief (similar to Child of Survivors Complex re: Jewish Holocaust survivors and
Practice - Focused Training in Prolonged Grief Disorder Therapy Day 2 Prolonged Grief Infographic Accept the reality Bereavement Acute Grief Restore capacity to thrive Defensive coping (Pause Points) Adapt to changes Integrated Grief Changes due to the loss Prolonged Grief Accept the reality Bereavement Acute Grief Restore capacity
Behind the Term: Trauma Prepared in 2016 by Development Services Group, Inc., under contract no. HHSS 2832 0120 0037i/HHSS 2834 2002T, ref. no. 283– 12–3702. 1 Behind the Term: Trauma Related terms: complex trauma, historical trauma, human-caused trauma, naturally caused trauma, trauma,
The assessed content included prima - ry survey, secondary survey, airway and ventilation, circulation, shock, thoracic trauma, head/spinal trauma, abdomen/pelvis trauma, musculoskeletal trauma, paediatric trauma, geriatric trauma, obstetric trauma, trans - fer of care, and other course specific inclusions.
categories of trauma as a framework for trauma assessment. “Little t” trauma “Big T” trauma Complex trauma “Little t” Trauma “Little t” trauma involves events that we encounter day to day that can make life difficult but are not out of the ord
to decide which workbook activities should be utilized. Prior to using this workbook, therapists should review Part III: The Grief -Focused Components of Treating Trauma and Traumatic Grief in Children and Adolescents (2nd Ed.) by Cohen, Mannarino, and Deblinger (2017). The Grief-Focused Components are covered in this workbook as follows:
Managing Trauma, Loss, and Grief in the Workplace 1. Understanding Trauma, . Just because the trauma isn’t a result of a significant incident, such as a shooting, doesn’t mean that it is . It is an event that is percei
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