The Biology of Hope

It’s hard to describe being in southern Arizona in July without using the words furnace and hairdryer(on the highest setting), but I’m happy to report I seem to be surviving by becoming vampiric in my habits. I limit my recreational activities to dawn or dusk, dash from one air- conditioned room to the next and I’ve started feeding on the blood of locals for extra iron…

In all seriousness, I’m very happy to be doing the dashing. The last four days have made me feel like I’ve saved the best stop ‘til last and I think much of that is to do with the sense that everything is finally coming together. After weeks of fighting the need to take everything in and understand it there and then, I’ve become much more able to sit back and soak in conversations and as a result my knowledge jigsaw seems to be at last forming a recognisable picture.

My newfound ability to relax into it more has allowed for some really meaningful conversations this week; no longer am I desperate to pin down someone’s definition of spirituality or get a clear cut answer on just what exactly the running order of a talking circle should be. I’ve just had some amazing chats, one human being to another, and I’m pretty sure this is what people have been telling me to do all along.

I wanted to share one of those conversations today as it’s been weighing on my mind. To set the scene, we’re in a blissfully air-conditioned room at the University of Arizona about to meet a Navajo lady who works for an initiative supporting native students in accessing healthcare training.

Having had my fair share of uncomfortable moments over the past few months, I’m a little better versed in saying and doing the culturally-sensitive thing around Native Americans and Alaska Natives. However, I still occasionally get caught off guard. In general when interviewing, photos and video recording have been a no-no and I’ve stuck to asking if I can record sound or simply take notes. This has for the most part been ok. On speaking to the Navajo lady in question, however, I immediately saw her distress at both suggestions and I felt terrible. She went on to explain that the idea of her spirit being contained on a recording device or even in written words bothered her and, with that, all implements were put away.

In this kind of work, it is a difficult line to straddle. What if you put the recorder away and later forget something really amazing that has been said? Or, what if you’re so focused on documenting an experience that you forget to be in it?

This has been a judgment I’ve had to learn to make and believe me I’m still learning! I’ve had to recognise how much of that decision is based on my own ego and my investment in sharing my experience; I’ve no doubt that my feelings of being very connected to people this week have come from letting some of that go.

But I digress, back to that air-conditioned room…

With a bit more of an understanding of the Native American belief system, there have been a few questions I’ve wanted to address for a while. In learning about the benefits of ceremony and traditional healing for both physical and mental health I’ve wanted to ask why, despite the reintroduction of cultural ways in many communities, the prevalence of issues such as youth suicide continues to rise. Sadly this topic came up on Tuesday without the need for prompting.

My companion was explaining her role as a learning aid in the reservation schools. She travels to Navajo Nation in northern Arizona regularly to assess for any special learning needs in the children and to help the teacher put those needs into a cultural context (e.g. is a child slow to read English because they have only spoken a native language previously?). She mentioned that during her last visit she had been made aware of four suicides at the school, two teachers and two pupils, in the space of a month. That’s four suicides in one school, in one month.

Such a terrible statement triggered so many questions in my mind but only one came out: why?

“They don’t have any hope”

I’ve asked that question of people more times than I can recount since qualifying as a doctor, ‘Do you feel hopeless?’, and yet I’m not sure I could tell you what it really means. The dictionary defines hope as ‘grounds for believing that something good may happen’ or ‘a feeling of trust’ but do either of these meanings really encompass the part it plays in our sense of well being?

Regardless, all I could think about in that moment, in that room, was a 12 year old without any.

I needed to unpick this further and so together we explored what it is within a culture that might instill hope; close family and community connections perhaps, a sense of belonging to something and an awareness of your roots, a recognition of your place not only within the people around you but within the world in which you live. In summary, a sense of meaning. These were all qualities I knew to be present in traditional Native American culture, a society that promotes connection to the land and a higher power through ceremony, encourages close relationships with family and community through story-telling and circles and a belief system that facilitates, through the teachings of the medicine wheel, a feeling of ‘wholeness’ and individuality.

I knew ceremony was happening in places where the lack of hope seemed to be greatest, so why then, if these traditions were still active, did people feel their lives were so lacking in meaning? ‘It’s complicated’ I was told. Darn.

We started with the idea of disconnection. Many young Native Americans are torn, some growing up with no traditional teaching at all and some hearing in one ear the benefits of the old ways and in the other feeling all the pressures of a modern, western society. They are ‘lost’ she told me and feel neither connected to the old or the new. To try to engage a person in a ritual that has no meaning for them is at best irrelevant and at worse alienating, but to lose all sense of where they have come from is terrifying.

We moved on to explore whether the traditional ways are indeed relevant to modern life; can today’s problems be addressed purely through ceremony?

Today’s world is certainly different, I was told, and yes it’s questionable whether certain processes can fully address the challenges we currently face. She offered the example of grief. In Native American culture it is traditional after a death to grieve for only four days and then move on. Knowing what we do about bereavement and the various paths it can take, it’s easy to see how this limited schedule might not be sufficient in allowing those affected to heal in the scenario of a suicide.

On hearing this though, I couldn’t help but think about my grandparents’ generation and how in a similar way historically within my own culture the trend has been to ‘keep calm and carry on’. Is it that we somehow feel more now, that we experience things differently, have we become less resilient or able to cope? Or is it that the problems we face are framed differently?

Just as I was about to spiral into a sea of confusion, I was rescued by a 2 hour telephone conversation with Tommy Begay, a Navajo Psychiatrist and scholar. Tommy has written extensively on the psychological and physiological impacts of trauma and was keen to tell me that no, in his opinion, it was not a case of the traditional ways being outdated or limited.

People always assume the problems are simply due to historical trauma. Of course generational trauma plays a large part, he affirmed, but fundamentally it comes down to the loss of culture that resulted from that trauma.

He asked me to imagine the scenario; a generation of Native Americans get removed from their families and put in boarding schools where they are largely abused and punished for being who they are. They are then returned years later without any knowledge of traditional ways and no idea of how to live. They have no idea how to parent, their only role models being the authority figures they experienced in the schools, and so go on to have children who again are not taught about their roots and are abused in similar ways to those that their parents experienced. Being disconnected from a culture that once promoted openness and story sharing, abuse becomes a taboo subject and is covered up. Without an outlet for these feelings of distress, substances are abused as a way of numbing the pain.

Native American culture is about more than sweat lodges and talking circles, he explained, it is about who you are in the world and who and what you are connected to. To be invested in the belief system is to have a completely different perspective on how you should experience life and the largest and most devastating impacts of the past have resulted in the loss of that concept.

He picked up the example of grief from earlier to try to demonstrate the idea of how Native Americans are encouraged to live. Traditional teachings promote a sense of positivity and a connection to the circle of life. A limited grieving period is not about preventing mourning or denying an outlet for emotion but is about the awareness of the return of celebration. He explained that when a life is lived regularly in ceremony, for every event, moment or milestone, death is considered simply a part of that journey and not an abrupt end to it.

So, if the lack of hope is directly related to the loss of cultural ideology; the loss of a sense of who we are and what we are connected to, how can that be put back?

“I think the next step is collecting saliva samples”

Not the response I was expecting.

Tommy went on to explain his current research and an hour later I think was beginning to appreciate just how enthralled by it I was. His interest lies in deconstructing the changes that occur in the human brain as a response to trauma.

The psychological phenomenon of altered behaviour patterns as a result of trauma is fairly widely accepted and documented, but this was one of the first conversations, certainly for me, which focused more on actual chemical change in the brain. Tommy has found that life experiences are having an impact on inflammatory markers circulating in the body, giving rise to both mental and physical health symptoms. This explained, he told me, amongst other things, the well documented trends of increased inflammatory chronic disease in the Native American population.

I was fascinated.

But the work doesn’t stop there. His hope now, he explained, is to gather a more ‘scientific’ evidence base of the benefits of ceremony by measuring the very inflammatory markers that are impacted by traumatic life events.

We have plenty of stories already, he wanted to make clear, plenty of examples of how these processes have helped people. But to really answer that question, of how we put back the things that have been lost, he believes the next step may be to look deeper into the biology behind it.

This conversation was so exciting for me and also felt groundbreaking in terms of putting some of the pieces of the puzzle together. A few blogs back I challenged you all to contemplate how we navigate that line between illness and experience, could this thinking be the answer?

As always, I want to bring it back to the patients that I see; not because it doesn’t have huge importance in this context but because I want to reiterate how I believe the solutions to our problems at home lie in learning from others.

As human beings, we’ve all experienced ‘trauma’ of some sort. If we can take these ideas on board; namely the concept that both mental and physical symptoms can be caused, or at least impacted, by life experiences in a much larger way than perhaps previously thought, it completely changes the focus of our assessment model. Based on this work, questions that focus on a person’s life experiences, social situation, family bonds; questions that are often disregarded in the pressure of time, should be prioritised. The aim shouldn’t be to jump to a diagnosis but to build a foundation of knowledge about that person in order to fully understand where their pain, whether it be physical or emotional, is coming from.

Most excitingly, though, is the idea that through Tommy’s amazing work we might begin to understand what can reverse those physiological changes that occur and facilitate the healing that needs to take place psychologically. By taking a slightly more biological look at ceremony, whilst not diminishing the spiritual aspects of it, we might be able to draw out elements that could benefit a variety of people, some of whom are not able to access it currently due to differing cultural belief systems.

Tommy is working to determine the ‘biology of hope’ and, in terms of what that means for doctors, patients and human beings everywhere, I'm beginning to feel pretty hopeful myself.


In respect of my interviewees' wishes I will not be sharing photos of them but will instead leave you with my cactus garden.

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