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© Maria Yellow Horse Brave Heart, PhD Historical Trauma and Unresolved Grief: Implications for Indigenous Healing and Research Maria Yellow Horse Brave.

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Presentation on theme: "© Maria Yellow Horse Brave Heart, PhD Historical Trauma and Unresolved Grief: Implications for Indigenous Healing and Research Maria Yellow Horse Brave."— Presentation transcript:

1 © Maria Yellow Horse Brave Heart, PhD Historical Trauma and Unresolved Grief: Implications for Indigenous Healing and Research Maria Yellow Horse Brave Heart, PhD Associate Professor of Psychiatry/Director, Native American & Disparities Research Center for Rural & Community Behavioral Health

2 © Maria Yellow Horse Brave Heart, PhD Omniciye Woiyaksape: Sharing Wisdom Council Project It is our way to mourn for one year when one of our relations enters the Spirit World. Tradition is to wear black while mourning our lost one, tradition is not to be happy, not to sing and dance and enjoy life’s beauty during mourning time. Tradition is to suffer with the remembering of our lost one, and to give away much of what we own and to cut our hair short….Chief Sitting Bull was more than a relation….He represented an entire people: our freedom, our way of life -- all that we were. And for one hundred years we as a people have mourned our great leader.

3 © Maria Yellow Horse Brave Heart, PhD Omniciye Woiyaksape We have followed tradition in our mourning. We have not been happy, have not enjoyed life’s beauty, have not danced or sung as a proud nation. We have suffered remembering our great Chief and have given away much of what was ours…. blackness has been around us for a hundred years. During this time the heartbeat of our people has been weak, and our life style has deteriorated to a devastating degree. Our people now suffer from the highest rates of unemployment, poverty, alcoholism, and suicide in the country. Traditional Hunkpapa Lakota Elders Council (Blackcloud, 1990)

4 © Maria Yellow Horse Brave Heart, PhD Intergenerational Parental Trauma I never bonded with any parental figures in my home. At seven years old, I could be gone for days at a time and no one would look for me….I’ve never been to a boarding school....all of the abuse we’ve talked about happened in my home. If it had happened by strangers, it wouldn’t have been so bad- the sexual abuse, the neglect. Then, I could blame it all on another race….And, yes, they [my parents] went to boarding school. A Lakota Parent in Recovery (Brave Heart, 2000, pp )

5 © Maria Yellow Horse Brave Heart, PhD Multiple Losses and Trauma Exposure Death of five family members killed in a collision by a drunk driver on a reservation road One month earlier, death of a diabetic relative Following month, adolescent cousin’s suicide and the death of another relative from a heart attack Surviving family members include individuals who are descendants of massacre survivors & abuse in boarding schools Many community members comment that they feel they are always in a state of mourning and constantly attending funerals.

6 © Maria Yellow Horse Brave Heart, PhD Presentation Overview Historical trauma theory The HTUG Intervention: A Tribal Best Practice HTUG and gender differences HTUG components and parenting study Preliminary research on perceived mental health and substance use problems and prevalence Indigenous Peoples Survey development Challenges in Native Research Celebration of Survival

7 Maria Yellow Horse Brave Heart, PhD The Development of Historical Trauma Theory and Interventions nformed by clinical, cultural/spiritual immersionMotivated by desire & commitment to reduce the suffering of Indigenous Peoples (1978); informed by clinical, cultural/spiritual immersion By 1992 – the first Native historical trauma intervention; presentations across the US & Canada 1996 – Designed the first Lakota/Native parenting curriculum incorporating historical trauma; number of SAMHSA grants 2009 – HTUG selected as a Tribal Best Practice by First Nations Behavioral Health Association, Pacific Substance Abuse & Mental Health Collaborating Council, and SAMHSA

8 © Maria Yellow Horse Brave Heart, PhD Historical Trauma and Unresolved Grief Historical trauma is cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma ( ) Historical unresolved grief accompanies that trauma (Brave Heart, 1998, 1999, 2000)

9 © Maria Yellow Horse Brave Heart, PhD Historical Trauma Response The historical trauma response (HTR) is a constellation of features in reaction to massive group trauma This response is observed among Lakota and other Native populations, Jewish Holocaust survivors and descendants, Japanese American internment camp survivors and descendants. (Brave Heart, 1998, 1999, 2000)

10 © Maria Yellow Horse Brave Heart, PhD Historical Trauma Response Features Survivor guiltSurvivor guilt Depression Sometimes PTSD symptoms Psychic numbing Fixation to trauma Somatic (physical) symptoms Low self-esteem Victim Identity Anger Self-destructive behavior including substance abuse Suicidal ideation Hypervigilance Intense fear Dissociation Compensatory fantasiesCompensatory fantasies Poor affect (emotion) tolerance

11 © Maria Yellow Horse Brave Heart, PhD Historical Trauma Response Features Death identity – fantasies of reunification with the deceased; cheated death Preoccupation with trauma, with death Dreams of massacres, historical trauma content Loyalty to ancestral suffering & the deceasedLoyalty to ancestral suffering & the deceased Internalization of ancestral sufferingInternalization of ancestral suffering Vitality in own life seen as a betrayal to ancestors who suffered so muchVitality in own life seen as a betrayal to ancestors who suffered so much

12 © Maria Yellow Horse Brave Heart, PhD Identification & Self-Hatred Identification with the aggressor (A. Freud) & internalized oppression (Freire)Identification with the aggressor (A. Freud) & internalized oppression (Freire) Identification with the oppressor’s view of Natives, resulting in self-hatred Self-destructive behavior (i.e. SA) to avoid pain and to act out the self-hatred Identifying with parents’ trauma response patterns

13 © Maria Yellow Horse Brave Heart, PhD The Takini (Survivor) Network is a Native non-profit organization (formed in 1992) designed to address healing from historical trauma and historical unresolved grief among the Lakota as well as other Native people through therapeutic work, prevention, research, publication and community education. The Takini Network

14 © Maria Yellow Horse Brave Heart, PhD Background: Genocide Native history meets UN 1948 Geneva Convention definition of genocide Congressional genocidal policy: no further recognition of their rights to the land over which they roam; go upon said reservations…chose between this policy of the government and extermination; wards of the government, controlled and managed at its discretion BIA Education Division called “Civilization Division” Congressional policy of forced separation of children from family and tribe; militaristic Gender roles and relationships impaired by boarding schools

15 Maria Yellow Horse Brave Heart, PhD Boarding School Era This bill provides for the utilization of vacant military posts and barracks for the industrial education of nomadic youth and the employment of officers of the army as teachers or to be otherwise detailed by the Department of War. Education as a means of civilizing and elevating the savage has ceased to be experimental. Best results are obtained with the removal of children from all tribal influence (US Congress, 1879).

16 Maria Yellow Horse Brave Heart, PhD Background: HT Theory, Trauma Exposure 2/3 of American Indian youth affirm multiple traumas (Manson et al., 1996) American Indians years had a trauma exposure rate of 62.4% to 69.8% to at least one traumatic event; a substantial proportion of these entail death of a loved one (Manson, Beals, Klein, Croy, & AI-SUPERPFP Team, 2005) American Indian males and females have similar trauma exposure rates in contrast with gender differences in the general population; AI women have greater rates than other women (Manson, et al., 2005)

17 © Maria Yellow Horse Brave Heart, PhD HT Theory & Symptoms of Depression, PTSD, Complicated/Prolonged Grief Suicidal behaviors were associated with depressive disorders, PTSD, & substance abuse/dependence (LeMaster, et al., 2004) Lifetime prevalence of 44%, 86% of these having major depression, were found in Native women (mean age 29.8 years) where 41% had attended Indian boarding schools (Duran et al., 2004 AmJPH); later study (2004 ChA&N), boarding school attendance not significantly associated with PTSD but did not assess quality of experience

18 © Maria Yellow Horse Brave Heart, PhD HT Theory & Symptoms of Depression, PTSD, Complicated/Prolonged Grief CG/PG: sadness, separation distress including strong yearnings, longing for and preoccupation with thoughts of the deceased, and intrusive images, psychic numbness, guilt, extreme difficulty moving on with life, and a sense of the part of the self having died (Boelen & Prigerson, 2007; Shear et al., 2005). CG may also co- occur with PTSD (20-50%); prevalence unclear for American Indians/Alaska Natives. 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 Intrusive images often come in massacre dreams, as if one is living in the 1800s and often dying tragically with ancestors (like transposition – Kestenberg)

19 © Maria Yellow Horse Brave Heart, PhD Prolonged or Complicated Grief Tribes may also be at high risk for CG/PG related to the impact of genocide across generations and frequent deaths of attachment figures, due to high morbidity and mortality rates, & generational boarding school trauma. Rather than ambivalent relationships, some CG researchers think that close attachments may predispose CG development; AI/AN attachment styles may be closer and more intense as a cultural norm

20 © Maria Yellow Horse Brave Heart, PhD HT Theory & Symptoms of Depression, PTSD, Prolonged Grief Native mourning resolution is distinct from European American grief Loss of close relative experienced as loss of part of self, exhibited by cutting the hair Natives maintain active relationship with ancestor spirits Massive group trauma (genocide) impairs normative grief; extent & quality of losses (trauma exposure) limit time for culturally congruent mourning resolution; history of prohibition of bereavement ceremonies

21 Maria Yellow Horse Brave Heart, PhD HT Theory, Depression, PTSD, Trauma Exposure, & Prolonged Grief American Indian males years old have greater prevalence of any lifetime depressive disorder, PTSD, or any anxiety disorder than general population For PTSD, American Indian male prevalence is 12.8% in SW and 11.5% in NP For any anxiety disorder, it is 15.9% and 13.1% compared to 8.6% among males in general population American Indian female rates are higher than American Indian males and than females in general population (females in general have higher rates of anxiety and depression) (Beals, et al., 2005)

22 Maria Yellow Horse Brave Heart, PhD HT Theory, Depression, PTSD, Trauma Exposure, & Prolonged Grief American Indian males have non- interpersonal trauma exposure rates of 25.2% in SW and 36.4% in NP, including natural disasters, life-threatening accidents (Manson, et al., 2005) Interpersonal trauma exposure rates (assault, rape, abuse, combat) – 25.5% in SW and 31% in NP for Native men Witness to trauma – 46.7% SW & 46.3% NP

23 Maria Yellow Horse Brave Heart, PhD Cultural Context & Grief Native mourning resolution is distinct from European American grief Loss of close relative experienced as loss of part of self, exhibited by cutting the hair Natives maintain active relationship with ancestor spirits Culturally, AI men more relational than white males, more similar styles of attachment to AI women Massive group trauma (genocide) impairs normative grief; extent & quality of losses (trauma exposure) limit time for culturally congruent mourning resolution

24 © Maria Yellow Horse Brave Heart, PhD Impact Upon Indian Parenting Many boarding school survivor parents report traumatic, negative experiences including physical & sexual abuse Boarding school survivor parents report a sense of self as being wounded and impaired in their competence as parents Descendants of boarding school survivors frequently report abuse and/or neglect in their own childhoods Need to examine regional, tribal, and generational differences

25 Maria Yellow Horse Brave Heart, PhD More HT Impact on Parents & on Gender Roles and Relationships Traditional gender roles and relationships impaired – women & children were never the property of men, sacredness of children lost, & men lost traditional parenting roles as well as roles of warriors and protectors Native men targeted for greater genocide – seen as more of a threat, higher bounties for male scalps, prohibition of long hair in past, impairment of traditional hunting and ways for men to express their Native manhood Many Native men internalized white male values, including the view of women & children as property due to forced socialization in boarding schools

26 Maria Yellow Horse Brave Heart, PhD More HT Impact on Parents & on Gender Roles and Relationships Older study found that Lakota women with greater degrees of traditional lifestyle, blood, and language fluency were healthier than less traditional women but more white-acculturated men were healthier than traditional males (Han, Hagel, Welty, Ross, Leonardson, & Keckler, 1994) Although study concluded that acculturation was more stressful for women, also implication that the pressures for traditional Native men seems greater

27 Maria Yellow Horse Brave Heart, PhD Young Native Men Often lack clear concepts of what it means to be Indigenous, what their roles should be in their communities Many carry distortions regarding the responsibility of being a true warrior Confusion stems from the early genocide and erosion of Native culture, resulting in violence, abuse, and oppression of peers, self-hatred, and self-destruction Rape on the Reservation - Vanguard TV series www. currenttv.com Evidence of internalized oppression

28 Maria Yellow Horse Brave Heart, PhD The Historical Trauma & Unresolved Grief Intervention: A Tribal Best Practice for Intergenerational Healing

29 © Maria Yellow Horse Brave Heart, PhD Historical Trauma & Unresolved Grief Intervention: A Tribal Best Practice Psychoeducation about genocide, boarding school losses, & oppression Use of audiovisual materials to stimulate memories and to educate participants about the traumatic historical context Small & large group processing and in dyads (pairs); exercises Focus as well on lifespan trauma Cathartic, traditional cultural experiences

30 © Maria Yellow Horse Brave Heart, PhD Historical Trauma Intervention: Four Major Intervention Components Confronting historical trauma and embracing our history Understanding the trauma Releasing our pain Transcending the trauma

31 Maria Yellow Horse Brave Heart, PhD The First HT Intervention1992 Quasi-experimental study, 45 Lakota, on effectiveness of group intervention on collective group trauma & grief Traditional culture & ceremonies throughout facilitated cathartic release of emotions Psychoeducation; narratives & trauma testimony Delivered over 4 days; random assignment to small process groups with the trained Native facilitators

32 Maria Yellow Horse Brave Heart, PhD Return to the Sacred Path Study (1992) Mean age of study population was % attended boarding school; mean age 8.9 years; 38.7% attended before 6 yrs, 48.4% before 7 yrs; mean distance from home mi, mode 300 miles Physical abuse (58.1%) & sexual abuse (22.6%) by staff Sexual abuse higher in male participants 90.7% reported parental boarding school attendance 50% reported death of a close relative in past year, 100% in the past two years Statistically significant differences on all scales of projective measures

33 Maria Yellow Horse Brave Heart, PhD Historical Trauma Intervention Research & Evaluation ( ) Reduction in sense of feeling responsible to undo painful historical past Decrease in guilt, shame, stigma, anger, & sadness Increase in joy and hope Improved valuation of true self and of tribe Increased sense of personal power

34 © Maria Yellow Horse Brave Heart, PhD Changes on the Lakota GEQ [Statistical significance achieved for 7 items including these (Brave Heart, 1995, 1998) ] ConceptM (T1)M (T2)PSignificance Shame p<.01 Stigma p<.01 Anger p<.05 Obsessive thoughts p<.01 Feeling responsible for undoing the pain of the past p<.05

35 © Maria Yellow Horse Brave Heart, PhD Semantic Differential Results: Changes Over Time Evaluation Scale – My True Self (P=.004, p<.01) –Anger (P=.032, p<.05) –The Past (P=.004, p<.01) –Wasicu (P=.001, p<.01)

36 © Maria Yellow Horse Brave Heart, PhD Semantic Differential Results: Changes Over Time Potency Scale - My True Self (P=.035, p<.05) - Wasicu (P=.002, p<.01) - The American Indian Holocaust (P=.000, p<.0001)

37 © Maria Yellow Horse Brave Heart, PhD Semantic Differential Results: Changes Over Time Activity Scale - The American Indian Holocaust (P=.012, p<.05) - The Past (P=.001, p<.01) - My People (P=.006, p<.01)

38 © Maria Yellow Horse Brave Heart, PhD Table 11: Gender Differences for Affects Experienced Often Before, During and After the Intervention Before Female/Male During Female/Male After Female/Male Anger70.6% 73.3%41.2% 66.7%11.8% 26.7% 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%0.0% 13.3% Joy58.8% 33.3%64.7% 66.7%70.6% 86.7%

39 Maria Yellow Horse Brave Heart, PhD Return to the Sacred Path Study (1992): Results for Men Men experienced greater degree of boarding school trauma including assault from staff for speaking Native language and sexual abuse Men had less conscious emotional experience of historical trauma yet reported more traumatic events in boarding schools Gender may have interacted with greater Indian phenotype (skin color & features) to place men at greater risk for lifespan trauma exposure Men may have used avoidance (common in PTSD and prolonged grief) to defend against their emotional pain, hence less awareness

40 Maria Yellow Horse Brave Heart, PhD Return to the Sacred Path Study (1992): Results for Men Men’s grief scores differed from women’s – they may have been in an earlier stage of grief resolution Men, however, were more conscious of survivor guilt than women For Lakota men in the intervention, guilt about the Wounded Knee Massacre was one probable explanation for differences before the intervention

41 Maria Yellow Horse Brave Heart, PhD Return to the Sacred Path Study (1992): Results for Men Men’s historical inability to enact their traditional roles as protectors during the Wounded Knee Massacre may have heightened initial (T1) defensive denial of shame and general guilt (as opposed to survivor guilt) and lessened conscious awareness of the Lakota historical trauma and its impact At T2, men reported increase in survivor guilt & shame as well as joy, suggesting an increase in affect (emotion) tolerance and a decrease in psychic numbing as well as greater consciousness of trauma response features

42 Maria Yellow Horse Brave Heart, PhD Gender Differences: Boarding School Experiences Experiences%Men%Women Attended boarding school 82.4% 65.4% Hit at boarding school 85.7% 35.3% Punished for speaking 57.1% 20.0% Racism in boarding school 85.7% 58.8% Sexually abused at school 28.6% 17.7% (Brave Heart, Gender differences in the historical trauma response, J of Health & Social Policy, 10(4), 1- 21)

43 Maria Yellow Horse Brave Heart, PhD Wakanheja (Sacred Children) Lakota Parenting Curriculum Content includes emphasis on traditional values, traditional parenting styles (pre-boarding school days) & traditional protective factors Includes review of risk & protective factors for effective parenting Includes the Historical Trauma & Unresolved Grief Intervention key components (HTUG) Includes the Woope Sakowin (Seven Laws) as a guide for parenting & effective parenting skills

44 Maria Yellow Horse Brave Heart, PhD Traditional Protective Factors: Woope Sakowin (7 Laws of the Lakota) Wacante Ognake - Generosity Wowaunsila – Compassion Wowayuonihan – Respect Wowacin Tanka - To Have a Great Mind Wowahwala – Humility, State of Silence, To be humble Woohitike – Courage, Bravery, Principal, Discipline Woksape – Wisdom, Understanding

45 Maria Yellow Horse Brave Heart, PhD Themes from Qualitative Evaluation of Parental Responses ( ) Increased sense of parental competence Increase in use of traditional language Increased communication with own parents and grandparents about HT Improved relationships with children, parents, grandparents, and extended kinship network Increased pride in being Lakota and valuing own culture, i.e. Seven Laws

46 © Maria Yellow Horse Brave Heart, PhD Indigenous Driven Research: Direct Descendants of HT Event Community sample of 486 urban AI/AN adults Direct descendants (DD) had higher perceived mental health problems, depression, PTSD, alcohol/drug problems, thought more about collective HT, followed by Don’t Knows (DK); Chi square showed significant differences DD had greater guilt and feeling responsible to undo pain of past collective trauma, followed by DK DD were more proud, more Native language comprehension, practiced traditional spirituality more, and felt more connected

47 © Maria Yellow Horse Brave Heart, PhD Direct Descendants of HT Event in Western Urban Sample Limitations – preliminary data – logistic regression analysis in process Implications – DD may also have come from more traditional family lineage and those who were “hostiles” – who resisted the cavalry DD may have had more trauma exposure and higher degree of Indian blood/more full-blood phenotype (skin color and features); could be older (checking) DK interesting – something about no knowing that is emotionally challenging Tribal differences suggested; some tribes may have had greater or more recent HT exposure, more DD in specific tribes; cultural differences in coping and grief resolutions

48 © Maria Yellow Horse Brave Heart, PhD Direct Descendants of HT Event in Western Urban Sample Trauma of boarding schools among direct descendants could have resulted in “fight” rather than “flight” – defiance, holding onto the language (oral testimony of refusal to cry during a beating) Admission of perceived mental health problem, including alcoholism, may be related to less stigma with sobriety movement and also participation in traditional ceremonies where cathartic release and openness are the norms; ceremonies role-model affect tolerance and expression (Brave Heart, Elkins, Carliner, in preparation)

49 © Maria Yellow Horse Brave Heart, PhD Indigenous Peoples of the Americas Survey (IPS) Funded by UNM RWJF Center for Health Policy Refine and pilot test an Indigenous Peoples Survey (IPS) instrument with 40 Indigenous adults living in Albuquerque; interest from tribal communities in different regions Sections for Indigenous Peoples from US & Canada; section for Indigenous Peoples from Mexico, Central, and South America

50 Indigenous Peoples of the Americas - Definition Indigenous Peoples of the Americas are a diverse population, with over 500 federally recognized tribes in the United States and over 400 in Latin America. Indigenous Peoples have experienced pervasive and cataclysmic collective, intergenerational massive group trauma and compounding discrimination, racism, and oppression. Indigenous Peoples of the Americas, terminology adopted by the United Nations Permanent Forum on Indigenous Issues, refers to the descendants of the original inhabitants of Canada [First Nations], the United States [American Indians/Alaska Natives], Mexico, Central and South America. © Maria Yellow Horse Brave Heart, PhD

51 IPS Content Inventory of Complicated Grief Trauma History Inventory/HTQ PTSD Checklist-Civilian Version Historical Loss Scale (Whitbeck) Center for Epidemiologic Studies Depression Scale Duke-UNC Functional Social Support Questionnaire Items from the Lakota Grief Experience Questionnaire (Experimental) and the Return to the Sacred Path Study (PI-constructed) Experiences of racism and discrimination Identity

52 IPS Provides preliminary data on the psychometric properties Finalize for research use by tribal communities who have identified a need for such an instrument Preliminary data on the nature and prevalence of the emotional challenges (depression, collective trauma exposure, interpersonal losses, and unresolved grief) © Maria Yellow Horse Brave Heart, PhD

53 Current HT Research Development Combine HTUG key components with culturally adapted evidence based practices or empirically supported treatments HTUG framed as treatment engagement HTUG reduces stigma and empowers American Indian/Alaska Native and First Nations communities through acknowledging the collective trauma across generations Pilot combined intervention with urban and reservation American Indians in NM and SD © Maria Yellow Horse Brave Heart, PhD

54 Research Challenges for Native Communities Lack of data on Native Peoples – limited inclusion of Natives in research on EBT/EBP Not fitting into the box Culturally responsive and Indigenous-lead research often innovative and doesn’t easily fit framework or process of standard funded research Traditional consensus and tribal politics; attending to alliances in the community, barriers from institutions e.g. gift cards, ss#, mistrust

55 © Maria Yellow Horse Brave Heart, PhD Case Examples 15 year old American Indian girl with recovering boarding school survivor parents attempts suicide 43 year old recovering alcoholic, with history of physical abuse and neglect by alcoholic boarding school survivor parents, experiencing suicidal impulses, depressed and unable to cry; placed on anti-depressants and in mainstream psychotherapy but symptoms are not alleviated

56 © Maria Yellow Horse Brave Heart, PhD Celebration of Survival Video Presentation: A Celebration of Survival: The Takini Network (supported by CSAT) –includes historic boarding school slides –summarizes historical trauma intervention theory and approach –describes historic 2001 Models for Healing Indigenous Survivors Conference Follow up conferences held in 2003 and 2004 (CMHS and CSAT funded)

57 © Maria Yellow Horse Brave Heart, PhD Website Developed by Raymond Daw (Dine’)

58 © 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 Health Responses and Practical Knowledge Gained. New York: Haworth Press. Brave Heart, M.Y.H. (2003) The Historical Trauma Response Among Natives and Its Relationship with Substance Abuse: A Lakota Illustration, Journal of Psychoactive Drugs, 35 (1), 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),

59 © Maria Yellow Horse Brave Heart, PhD References Brave Heart, M.Y.H. (1999) Oyate Ptayela: Rebuilding the Lakota Nation through addressing historical trauma among Lakota parents. Journal of Human Behavior and the Social Environment, 2(1/2), Brave Heart, M.Y.H. (2000) Wakiksuyapi: Carrying the historical trauma of the Lakota. Tulane Studies in Social Welfare, 21-22, Brave Heart, M.Y.H. (2001) Clinical assessment with American Indians. In R.Fong & S. Furuto (Eds), Cultural competent social work practice: Practice skills, interventions, and evaluation (pp ). Reading, MA: Longman Publishers. Brave Heart, M.Y.H. (2001) Clinical interventions with American Indians. In R. Fong & S. Furuto (Eds). Cultural competent social work practice: Practice skills, interventions, and evaluation (pp ). Reading, MA: Longman Publishers.

60 © 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 2 American Indian reservation populations. Archives of General Psychiatry, 162, Beristain, C., Paez, D. & Gonzalez, J. (2000). Rituals, social sharing, silence, emotions and collective memory claims in the case of the Guatemalan genocide. Psicothema, 12(Supl.), Duran, BM, Sanders, M, Skipper, B, Waitzkin, H, Malcoe, LH, Paine, S, & Yager, J. (2004). Prevalence & correlates of mental disorders among Native American women in primary care. American Journal of Public Health, 94(1), Huang, B., Grant, BF., Dawson, DA.,Stinson, FS., Chou, SP, Saha, TD, Goldstein, RB, Smith, S.M., Ruan, WJ, & Pickering, RP. (2006). Race-ethnicity & the prevalence & co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol and drug use disorders and Axis I and II disorders: United States, 2001 to Comprehensive Psychiatry, 47,

61 © Maria Yellow Horse Brave Heart, PhD References Indian Health Service (2001). Trends in Indian Health Washington, DC: U.S. Department of Health & Human Services. Legters, L.H. (1988). The American genocide. Policy Studies Journal, 16 (4), Lewis-Fernandez, R. & Diaz, N. (2002). The cultural formulation: A method for assessing cultural factors affecting the clinical encounter. Psychiatric Quarterly, 73(4), Manson, S., Beals, J., O’Nell, T., Piasecki, J., Bechtold, D., Keane, E., & Jones, M. (1996). Wounded spirits, ailing hearts: PTSD and related disorders among American Indians. In A. Marsella, M. Friedman, E. Gerrity, & R. Scurfield (Eds), Ethnocultural aspects of Posttraumatic Stress Disorder (pp ). Washington DC: American Psychological Association. Robin, R.W., Chester, B., & Goldman, D. (1996). Cumulative trauma and PTSD in American Indian communities (pp ). In Marsella, A.J., Friedman, M.J., Gerrity, E.T., & Scurfield, R.M. (Eds), Ethnocultural aspects of Post-traumatic Stress Disorder. Washington, DC: American Psychological Press

62 © Maria Yellow Horse Brave Heart, PhD References Robin, R., Chester, B., Rasmussen, J., Jaranson, J. & Goldman, D. (1997). Prevalence and characteristics of trauma and posttraumatic stress disorder in a southwestern American Indian community. American Journal of Psychiatry, 154(11), 1582–1588. Shear, K., Frank, E., Houck, P.R., and Reynolds, C.F. Treatment of complicated grief: A randomized controlled trial, 2005, JAMA, 293 (21), US Senate Miscellaneous Document, #1, 40th Congress, 2nd Session, 1868, [1319]

63 © Maria Yellow Horse Brave Heart, PhD References Brave Heart, M.Y.H. (1999) Gender differences in the historical trauma response among the Lakota. Journal of Health and Social Policy, 10(4), Brave Heart, M.Y.H. & Spicer, P. (1999). The sociocultural context of American Indian Infant Mental Health. World Association of Infant Mental Health Handbook of Infant Mental Health. J.D. Osofsky & H.E. Fitzgerald (Eds.). John Wiley & Sons. Brave Heart, M.Y.H., & De Bruyn, L. (1998). The American holocaust: Historical unresolved grief among native American Indians. National Center for American Indian and Alaska Native Mental Health Research Journal, 8(2),

64 © Maria Yellow Horse Brave Heart, PhD Additonal References Boelen & Prigerson, 2007 on Prolonged Grief Duran, B. (2004) CA/N article Manson, Beals, Klein, Croy 2005 Walters, K. (2004) Presentation at HT conference, New Mexico, December, 2004


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