Traditional perspectives on child and family health

Abstract

First Nations and American Indian communities experience significant health disparities compared with the general populations of Canada and the United States. Children from these communities experience higher rates of infant mortality, suicide and unintentional injury. From a traditional Lakota perspective, many of the health disparities faced in Aboriginal communities are linked to imbalances in the family and community. These imbalances can lead to detrimental behaviours, including substance abuse, alcoholism and domestic violence. The Medicine Wheel is a traditional symbol that can be used to attain a better understanding of these imbalances and how they relate to family and child health. However, significant differences exist between the perspectives of modern medical science and traditional cultures. To promote wellness and to prevent morbidity and mortality in a culturally appropriate way, current efforts need to focus attention on traditional cultural values and perspectives that incorporate the balance of the community and the health of the family. Traditionally, we understood that the health of the family and community has a significant impact on the health of children. To more effectively promote health and to prevent imbalance, children from these communities need to understand traditional values and to feel that they are an important link between traditional culture and future generations.

“A child is sacred. And when that child comes into the home, the family must welcome it. And if the child is happy and feels the want, he will come into this world very, very strong. And not to know this is to know nothing.”

–Blackfeet

I was privileged to grow up in a family with many traditional leaders, healers and medicine men. My traditional name is Pejuta Wicasa, which means “Medicine Man” in the Lakota language. I was named after my grandfather on my mother’s side in a traditional ceremony on the Pine Ridge Indian Reservation in Kyle, South Dakota, USA. I have several uncles who are practicing traditional healers, and I was fortunate to learn traditional philosophy from them starting at an early age. When I was considering going to medical school to receive formal medical education, my family was very supportive because they knew that the only way we can successfully integrate traditional philosophy into modern medicine is if more of our own people become educated in modern medical science. I was told by the traditional members of my family to go to their best schools and to learn and understand their form of medicine.

The differences between modern allopathic and traditional Lakota approaches to medicine and health are significant. Much of the distinction can be described by understanding the term allopathic. ‘Allopathic’ comes from two Greek words, allos and pathos. Allos means opposite or other, and pathos is disease or suffering (eg, pathology is the study of disease). Therefore, in allopathic medicine, our goal is to produce the opposite effect of the disease or symptom that we are treating. This is why so many classes of medications are ‘anti’ something. For example, antibiotics, antihypertensives, antidepressants and anti-inflammatories are commonly used treatments in allopathic medicine. Conversely, traditional Lakota medicine uses a holistic approach in which health is seen as a balance among spiritual, mental, physical and emotional forces.

Modern medicine focuses primarily on treating diseases, and traditional medicine focuses on promoting balance and health. It is ironic that we call ourselves ‘health care providers’ in modern medicine because the majority of our efforts are focused on treating disease. In reality, we are disease care providers in modern medicine. Contrarily, treating disease is one component of a larger picture of health promotion in traditional medicine. The narrow focus of allopathic medicine is not adequate in terms of addressing the holistic nature of how disease processes are experienced by individuals. Some of the primary differences between modern and traditional medicine are summarized in Table 1.

TABLE 1.

Differences between modern allopathic and traditional Lakota medicine

	Modern	Traditional
Model	Allopathic	Holistic
‘Medicine’	Physical	Spiritual
‘Health’	No disease	Balance
Provider	Physician	Healer
Focus	Treat disease	Promote health
Goal	Cure/manage disease in the individual	Community health
Values	Confidentiality	Family/community participation
Honours	Physician for curing	Patient for wellness
Symbol	Serpent and staff	Medicine Wheel

From a traditional perspective, the health of the community and the family determines the health of the individual. Unfortunately, in modern times, American Indian and First Nations communities suffer from significant health disparities when compared with the general population. Unhealthy communities produce unhealthy families, and our children suffer from high rates of preventable diseases as a result. For example, in both Canada (1) and the United States (2), American Indians and First Nations people have shorter life expectancies than do the general population, and infant mortality and deaths caused by unintentional injuries or suicide are significantly higher than in the general population.

Recent studies have identified numerous potential causes of health disparities, including genetics, access to health services, poverty (3), income distribution (4) and discrimination (5). However, from a traditional Lakota perspective, much of the adversity that our communities face is rooted in the loss of land, traditional culture and lifestyle. As stated by my uncle Rick Two Dogs, “We need to understand that the primary reason our people are so afflicted with addiction, poverty, abuse and strife, is that our way of life was taken from us. Everything was taken. And nothing was replaced” (6).

Traditionally, our people lived in balance as individuals, families and communities. The Medicine Wheel is a useful symbol to promote understanding of traditional balance. In Figure 1, the Medicine Wheel represents an individual, and to be healthy, the individual must live in balance among spiritual (east), mental (north), physical (west) and emotional (south) forces.

Figure 1.

The Medicine Wheel

From a traditional perspective, the loss of ancestral homelands, culture, language and other components of traditional life has led to a deeply rooted loss of identity as Native people. This sense of loss can be seen as a spiritually and emotionally based imbalance that has resulted in self-destructive behaviours, including alcoholism, substance abuse, domestic violence and suicide. Another way to envision the Medicine Wheel is to examine traditional systems of values, decisions, actions and reactions (Figure 2).

Figure 2.

Values, decisions, actions and reactions Medicine Wheel

From a spiritual perspective, we interpret our values into decisions in the mental realm. We implement our decisions into actions in the physical realm, and our actions produce reactions in the emotional realm. These reactions and emotions provide feedback and input into the value system, allowing for reevaluation of our decisions and actions (behaviours). This system of understanding allows for continuous reevaluation and self-discovery. However, the history of child abuse in boarding schools, and the loss of land and culture has also led to a loss of traditional values. When the traditional value system is excluded from the circle, self-destructive behaviours, such as alcohol abuse, can occur (Figure 3).

Figure 3.

Alcohol abuse and the Medicine Wheel

Unfortunately, one of the manifestations of imbalance and substance abuse in the home is domestic violence. This has had a significantly detrimental impact on the physical, emotional and spiritual health of our children. Traditionally, Native men were the protectors of the family and community. The spiritual illness brought about from loss of culture, language and land has led to recent generations of men abusing women, and adults abusing or neglecting children. From a traditional perspective, and by using Medicine Wheel symbolism, it can be seen how treating and preventing alcohol abuse and other self-destructive and family-destructive behaviours requires a spiritual healing process and a return to traditional values. Fortunately, in the United States and Canada, many recovery programs and treatment centres designed for American Indian and First Nations youth and adults employ traditional healers and use traditional ceremonies to promote spiritual healing.

One of the initial steps in this process of spiritual healing is to understand traditional values and to identify the basis for decision-making. In Lakota philosophy, there are seven traditional values that correspond to the seven directions – east, north, west, south, up, down and within. The traditional values are fortitude (east/spiritual), wisdom (north/mental), courage (west/physical), generosity (south/emotional), honour (up/father sky), respect (down/mother earth) and humility (centre/within) (Table 2).

TABLE 2.

Traditional values and the seven directions

Traditional value	Direction
Fortitude	East
Wisdom	North
Courage	West
Generosity	South
Honour	Up
Respect	Down
Humility	Within

The Medicine Wheel can also represent traditional values when considered in three dimensions (Figure 4).

Figure 4.

Traditional values and seven directions Medicine Wheel

Fortitude can be seen as the inner strength or inner fire that allows an individual to persevere in the face of adversity. Wisdom is the ability to make the right decisions, not just for self, but for family and community. Courage is the willingness to put oneself in harm’s way to protect family and community or to advance a higher cause or purpose. Generosity is the giving of possessions, time and energy to others so that they may prosper. Honour is having integrity and honest character – being one who can be trusted. Respect is understanding the importance of all creation, including people, animals and earth. Humility is the core value – understanding that the values and gifts given to us by our creator are not meant only for personal gain. Our purpose is to protect, heal and advance our communities for the benefit of future generations. Using these values as a basis for decision-making can make the way in which we live our lives balanced and meaningful, and it is a beautiful way to teach our children to behave and to interact with the world around them. The best method to teach theses values is by example. In this way, it can be seen how healing our communities and families in terms of promoting traditional values is an important component of promoting health in our children and in future generations.

In the traditional Lakota way, we are taught to pray for the next seven generations to come. Personally, I feel a great deal of strength in knowing that my ancestors from the previous seven generations prayed for my well-being. This gives me fortitude and courage, and it strengthens all the traditional values. It also helps me to feel a strong sense of connection to future and previous generations, and that I am a vital link in a chain of generations in my family.

Our youth need to feel that they are an important link in the chain of their families and communities. Considering that most of the morbidity and mortality in First Nations youth is preventable (eg, injuries and suicide), it is imperative to identify the most effective means to promote health and prevent injury, illness and death. It is clear that the health of the community and the health of the family have a significant impact on the health of the children. Therefore, a focus on child health also needs to include promotion of health in the family and in the community. Perhaps the first and most important step toward reducing health disparities is to identify and strengthen local cultural belief systems. The traditional ways of the Lakota and other tribes provide a culturally appropriate, holistic and meaningful way to promote community health. As stated by Joseph M Marshall III in his book The Lakota Way: Stories and Lessons for Living (7):

“A cornerstone of Lakota culture can be summed up in the words family and kinship. Family is the backbone, the foundation of our culture. We are given substance, nurtured, and sustained by family. Kinship goes beyond family and is the connection we feel to the world at large and everything in it.”