From one human being to another

It’s fair to say that I’ve found myself in some unusual social situations over the years; from crochet work in an Orcadian village hall to stone-cold sober karaoke with Japanese businessmen...but I’ve always found that throwing myself into a scenario, no matter how bizarre, has proved fruitful in connecting me to a community.

Acceptance hasn’t always come easily however; being rejected from the ‘Hoy-keleles’, Hoy’s esteemed ukulele society, and a Norwegian choir for lack of ability and inadequate language skills respectively were, whilst both justified, two low points that spring to mind.

No previous experience though can quite compare to the awkwardness I felt on sitting down with the Wabanaki womens’ beading group on Tuesday afternoon. Of course I didn’t make it easy for myself; after sitting in someone’s ‘usual chair’, wrongly identifying the person next to me as the teacher whilst ignoring my actual mentor and finally having to confess that no, I did not have any equipment, beads or beading skills of my own, I was about ready to sink into a hole in the floor and never emerge again.

I’d like to be able to say things quickly turned around, they didn’t. In reality what followed was an uncomfortable two hours of reluctant conversation on my companions’ part interchanged with jokes clearly made at my expense. I gritted my teeth and settled in for a long afternoon.

But then something amazing happened: on my fortieth minute of trying to thread a needle (I kid you not) my mentor turned her full attention to me and for the rest of the day, with a patience I can’t quite believe, manoeuvred me into creating a pretty decent beaded earring(or half of one at least).

By the end of the session, I’d received two hugs, a home-made dream catcher and an invitation to return tomorrow for a further lesson. I’m not quite sure how it happened but at some point during those three hours it seemed they’d decided I was ok.

Later, whilst sipping Maine’s finest Allagash beer with my hosts Lewis and Barbara, I told my story. They responded with reassurance that I wasn’t alone; they’d been here over 20 years and were still waiting to be invited to things. It turns out ‘being invited in’ is a big deal here and it doesn’t come easily.

As the week has progressed in Orono, I’ve come to learn more each day about the native people living in the area and have in turn been able to make some sense of the lack of welcome that day. Their story as a tribe and as a wider nation is a tragic one and having been made aware of some of the details, whilst I have not personally wronged them, I can more than understand their lack of trust. Frankly, I’m astonished I received the kindness that I did; I’m not sure it would have been unreasonable to leave me struggling with that needle and thread all night.

The local tribe are Penobscot, a nation of the Wabanaki Confederacy. Having once lived and thrived over a large area of Maine, their tribal land now consists only of a small island reservation, so-called ‘Indian Island’.

The atrocities these people have suffered historically at the hand of colonists are many. Reading the list is distressing, but meeting today’s tribe members, still so affected by the past, is heartbreaking.

The impact of past traumas on present day Native Americans is complex and multifactorial; firstly, it’s important to note that many of these ‘past events’ actually occurred very recently in historical terms. For example, Indian children were still being removed from their parents and forced into white foster care into the 1960s and 70s and it wasn’t until 1978 that a law was passed deeming it acceptable for Native Americans to ‘believe in whatever God or spirit they so choose’.

Recurrent moves such as these, on a consistent foundation of broken treaties and trust, ensured a swift and determined destruction of the Native American culture, but the period following this initial repression has as big a part to play in the issues affecting Native Americans today.

I’ve heard a number of times this week that ‘natives were set up to fail’ in the resettlement period and in looking at how reservations were established this indeed seems to be the case. Complex laws around ownership resulted in the inability for tribe members to own their own land and build property, a situation that is still true today and accounts for the high number of mobile homes seen on reservations. This coupled with a lack of outside business investment, due to ambiguous connections between Indian and mainstream affairs, has resulted in a degree of poverty on most reservations that is unrivalled by any other area in the US. This abject poverty on top of extreme trauma and decades of cultural repression has left a void in many native people, how could it not? And in an attempt to fill this hole many have turned to abusing substances, primarily alcohol, resulting in what South Dakota natives term ‘the liquid genocide’.

I’m familiar with the concept of ‘historical trauma’ in terms of ‘inherited’ mental health problems but haven’t previously considered the idea that seemingly ‘modern’ issues and behaviour patterns can also be directly related to the influence of past events. As well as the example of substance abuse, decades of being penalised for their beliefs and culture and having to rely on handouts to sustain life has devalued many Native Americans views of their own worth and the worth of those around them, mirroring how others have perceived them historically. This in turn has enabled devastating abuse within tribes, often repeated with every new generation, as well as tolerance of abuse inflicted by those outside of the culture. Much of this abuse goes unreported, an example of this being the number of native women murdered each year; cases that are rarely investigated in some parts of the US.

Though hard, it’s been really important for me to try to understand the context in which I’m seeing people here and also to consider the impacts of their history on their behaviour now. As a doctor, I’ve been no stranger to people in distress but where in the past I’ve perhaps neglected to seek out the story behind that distress, I have new clarity on the importance of background when trying to offer support. In knowing more about the Penobscot story I’m much more able to appreciate where people are coming from and also to understand why having a cultural orientation to the management of mental health problems is crucial. I, like many of the people I’ve met in the last few days, believe that to truly help someone we need to reject the idea of trying to ‘fix something’ superficially but strive to heal people from the roots up and for many people here that means reconnecting with an identity that for them has been lost. Some of the therapies and processes I’ve had the privilege of observing in Orono have been a true testament to this idea and have inspired me to reflect on how a similarly culturally-focused approach might benefit patients at home, each with their own story. I look forward to sharing some of these processes in time.

I fear I’ve digressed and fallen back into my habit of essay-writing, but if you’re still with me, I hope you’ll appreciate the necessity of doing so. To come to an end, with a clearer context, I’ll return to the topic of trust and attempt to describe how the last week has challenged my thoughts on what it is to connect with another person in this kind of setting and the idea of acceptance.

I’ve always been surprised and humbled at the extent of exposure and access I’ve been granted when conducting research in foreign settings. It’s hard when making that initial reach out to not come across as cold and clinical as the word ‘access’ might suggest, and I’m always desperate to convey to people that my real desire is to learn from them. That can be a difficult message to get across, especially when navigating other cultures, because stereotypes do exist and I’m not immune to judgement being passed.

I fell victim to this on Wednesday when I turned up at the Wabanaki Behavioural Health Clinic ready to spend the day shadowing the team and the staff seemed surprised that I was ‘young and female’ and ‘also a doctor!’. Luckily they came around to the idea and granted me permission to accompany firstly a nurse and latterly the police on visits to native patients suffering the impacts of drug addiction and homelessness.

It was during a home visit to a young woman refusing to be hospitalised for a likely drug-related blood infection, that I recognised the woman sitting next to her, her mother, as a fellow beader from the day before. On making this connection, I became acutely aware of my presence there and of the enormous privilege it was to be party to such a personal situation. I was concerned that my appearance in both a social setting yesterday and now a clinical one today might be unnerving and and/or offensive to the lady in question and suddenly felt very different, very foreign and very white.

The nurse accompanying me, Andrea, is the epitome of wise. Native herself, she has come out of retirement to support the growing demand for mental healthcare in the population and complements her knowledge of western medicine with a cultural understanding and manner that I’m sure is invaluable. On the way to the visit she told me about the healing power of cedar leaves and insisted we pick up some en route to bring to the patient. This gesture coupled with her gentle way of connecting with both mother and daughter put them at ease almost instantly and I’m sure was key in enabling my presence at the meeting. As a result, afterwards, we were thanked profusely for doing what on paper might appear very little.

In that moment I was incredibly grateful for the trust Andrea had put in me, really not knowing me at all, and the experience I’d been able to have as a result. On leaving the apartment the patient’s mother, the very talented beader, looked me in the eye and shook my hand. I was taken aback by how much it meant to me. I later learned she too is a recovering addict, having used heroine as recently as 6 months ago. She had fled an abusive situation in New Mexico with her six children years before and is now trying to pick up the pieces while they still continue to fall.

I returned to the clinic to meet with Sharon, a native Penobscot woman and social worker who founded the service 30 years ago. I liked her immediately and found her easy to connect with; while she feels deeply the hurts of the past her many life experiences and personal growth have given her an air of objectivity and distance that allows for meaningful conversation. She understands and relates to the traumas that still haunt people but also sees the space for change and is passionate about bringing it about.

We talked about the idea of stereotypes and I felt able to share my own feelings of how people had regarded me in my first few days in Orono. She replied that ‘while human beings might have differences, they have more similarities. Native people have been told for so long that they are different and that they are inferior, they have come to believe it. The psychological barriers to forming connections with others are now so great they even separate themselves within their own population, penalising those with “less true native blood” in a destructive pedigree system’.

Moving to lighter topics we joked about the doctor stereotype, the idea that a physician should be male, of a certain age and paternalistic. She laughed but said that for many this is still the case, ‘people are used to doctors not listening or really seeing them as people. It is people like Lewis and Ben, my host and a GP working on the reservation respectively, that are breaking that mould’.

She concluded by adding ‘I can see that you are breaking that mould too’ and I mention that not to be gushing (though I have to admit I choked up in the moment) or to be in any way self-congratulatory, but because I hope after reading this long ramble it will be obvious as to why that meant a huge amount to me. On this journey, to be seen as simply another human being, with more similarities than differences, eager to learn and determined to listen, is an honour and the best thing I can hope for.

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