Native American Indian Health Care Practices
Although each Native American Indian community-based medical system has its distinct characteristics, all share the following rituals and practices. • Sweating and purging. Both techniques are intended to purify the body as well as the spirit. Herbal preparations, such as the famous "black drink" of the southeastern tribes, were formerly used to induce vomiting (Hudson, 1979). The goal was to strengthen the body and prepare it for challenges--a form of preventive medicine. Sweating continues to be widely practiced, often in special "sweat lodges" (McGaa, 1990). Typically, these are small conical structures where hot rocks are doused with water to create steam. Participants pray, sing, and drum to purify their spirits while sweating to cleanse their bodies. This practice is also considered a means of preventing imbalance and illness; in some cases it is also used to heal. In the Lakota community, a complete lodge ceremony lasts several hours and is recommended both for general purification (e.g., monthly for men, a kind of parallel to women's monthly menses) and for help in reaching major life decisions or dealing with major ~life challenges. In addition, praying in the sweat lodge commonly precedes and follows vision questing and sun dancing. • Herbal remedies. All indigenous Americans depended on a variety of herbal remedies gathered from the surrounding environment and sometimes traded over long distances. The "Herbal Medicine" chapter gives more details on the types and applications of herbal remedies used by certain tribes. • Shamanic healing. Shamanic healing is also an important part of virtually all Native American Indian health care. Most tribal people have one or more types of health care specialists in naturalistic or personalistic healing. Frequently, the two overlap--thus a midwife or a medicine man or woman might focus primarily on naturalistic explanations and healing but sometimes also uses prayer, suggestion, or other techniques characteristic of a personalistic framework. "Holy people" or shamans (each tribe has its own name for this specialist type) emphasize personalistic healing but often are also knowledgeable about herbs, massage, and other naturalistic techniques.~Shamanic practice is relatively well maintained in a number of tribes today and in several cases is expanding into the larger society. On the other hand, herbal and other practices have largely disappeared in many localities. There are some current efforts to save vanishing knowledge, and the next few years may see more young people apprentice themselves to elders and become naturalistic or personalistic healing specialists. Below, major practices in two Native American Indian tribal communities are briefly outlined: the Lakota Sioux and the Dineh (Navajo). These two were selected because traditional healing practices have been relatively well maintained and well studied in these communities, and because they help to show the wide variety of practices used by Native American Indian peoples. There is a large literature on different groups, however, and the reader is also referred to sources such as Johnston, 1982; Morse et al., 1991; Naranjo and Swentzell, 1989; and Young, 1989. Lakota practices. The Lakota--one of several branches of a tribe often called Sioux, who live primarily in North and South Dakota, Minnesota, and Manitoba--are perhaps unique in ~their recent efforts to inform the wider society of their psychosocial healing techniques (Black Elk and Lyon, 1990; McGaa, 1990; Neihardt, 1932; Powers, 1977, 1982). Though the Lakota have their own distinctive ways of practice, in broad outline their techniques are shared with other Plains tribes as well as with other groups from Wisconsin to Washington (Farrer, 1991; Harrod, 1992; Storm, 1972; Yellowtail and Fitzgerald, 1991). Lakota techniques are based on the assumption of the absolute continuity of body and spirit; for the Lakota, "medicine" and "religion" are not separate. The two most famous Lakota religiomedical practices are the sweat lodge and the medicine wheel (sacred hoop.) Other techniques, such as the vision quest and sun dance, are familiar to many non-Native American Indians. Other practices, such as the yuwipi ceremony (Powers, 1982), are little known to outsiders. All these healing ceremonials are led by specialists, usually called medicine women or men or holy men or women, who are essentially shamanic in their approach to healing (Hultkrantz, 1985). Some also have knowledge of herbal remedies or manipulative techniques. One ~usually discovers that one's path is to become a medicine person through a dream or vision, sometimes sought (as in the vision quest), sometimes unsought (appearing during the course of serious illness or in lucid dreaming). Shamanic skills also tend to run in families. Once called, one seeks training, usually by apprenticing oneself to a successful medicine man or woman, often for several years. Training is complete when the teacher says it is complete and when the candidate has practiced his or her skills publicly and with success. The medicine wheel or sacred hoop is both a conceptual scheme and a major ceremonial. The wheel or hoop represents all of cosmology and life in a circle of four quarters, plus the directions of up, down, and center. Each of the four quarters has a character or power, which can be expressed in many ways; as an aspect of some form of wisdom, as an animal, as a color, as an energy, or as a season. The four quarters are separated by two "roads," one red for happiness, one black for sorrow. Everyone is born with the gift of one of the powers, and the thoughtful person will "journey" his or her life to develop the other forms of wisdom, know that happiness and sorrow come to everyone, and recognize the relatedness of the whole. This deeply ecological cosmology is expressed in virtually all Lakota prayer, ~and with the phrase "Mitakuye oyasin" ("Thanks to all our relatives"). The wheel or hoop is represented on much Lakota artwork; periodically it is represented as a stone circle on the ground, around which a ceremonial is held. Participation in the ceremonial is considered generally healing, and in addition, individuals can seek specific healing through prayer. Dineh or Navajo practices. The Dineh are a herding people who have lived in the southwestern United States for some centuries; they are the largest tribe in North America today. Like the Lakota, in their traditional practice the Dineh make essentially no distinction between reli-gious and medical practices. Here, discussion is limited to the famous Navajo healing "sings" or "chants" and the specialists who make them possible (Luckert and Cooke, 1979; Morgan, 1931/1977; Reichard, 1939, 1950; Sandner, 1979, 1991; Topper, 1987; Wyman and Haile, 1970). A sing is a healing ceremonial that lasts from 2 to 9 days and nights. It is guided by a highly skilled specialist called a "singer." Although focused on helping an individual, sings are commonly attended by as many in the community as can come, for just being present is ~considered healing. Navajo cosmology teaches that health is present when all things are in harmony. The full concept is impossible to translate into English, so it is often rendered as the Navajo word hozro, which summarizes many things such as happiness, connection, and balance. Its opposite is something like "evil"; indeed, where there is disharmony, there is sickness and disease, and vice versa. A long-time student of Navajo singers notes: This "evil" must be controlled or banished and goodness restored. To implement this desired state of affairs, the Navajos have created a great body of symbolic rituals [that] attempt to placate or expel the destructive powers and attract the good, helpful ones. By doing this they reestablish the basic harmony, cure individual illness, and bring general blessing to the tribe (Sandner, 1979, p. 118). There are three basic categories of chants: "holyway," "ghostway," and "lifeway." Holyway chants--including the most famous, called "blessingway"--are used to attract good, to cure, and to repair. Ghostway chants are used to remove evil and are often performed to heal Dineh who have had too much contact with strangers (non-Navajo), as in the armed forces ~or at college, or who have had contact with dead bodies. Lifeway chants are used to treat what westerners would call "physical" injuries and accidents; such treatment includes both restoring cosmological harmony and repairing trauma--by setting broken bones, for example. The two kinds of healing specialists among the Dineh are the "diagnosticians" and the aforementioned singers. Diagnosticians are usually "called" to their profession by nonordinary experiences and receive little formal training in their skill. They diagnose deep cause by going into trance. While in trance, "hand tremblers" pass their shaking hands over the body of the patient; when the hands stop trembling, the locale of the illness is shown and the cause is usually nameable. "Star gazers" also enter trance to read cause in the stars. "Listeners" do not go into trance but listen to the patient's story and on that basis diagnose deep cause. Once cause is known--and it is always phrased in terms of harmony and disharmony--patients seek a singer who can provide the indicated treatment. Singers are specialists of symbology who have a good deal in common both with priests and ~with psychotherapists; in addition, their moral probity and high intellectual powers mean that they usually perform as community leaders as well. They are not shamans and are not "called" by supernatural powers to their profession. Instead, interest and patience are the prerequisites, as well as demonstrated dependability and economic success. To learn a single chant can take up to several years, for the performance of each chant involves memorizing what amounts to a long epic poem (one that takes 2 to 9 nights to repeat) along with the recipes for the accompanying herbal preparations and sand paintings. The singer must also know where to find the herbs, how to prepare them, and how to use them. He must know where to find the colored sands necessary for the sand paintings, and he must learn to make--without error--the intricate sand paintings specific to the chant he is learning. Because the training is so arduous, most singers learn only a few chants in a lifetime. The Dineh have depended on singers and chants for many centuries; today they are used in combination with conventional medicine. It remains common for Dineh both on and off the reservation to seek sings to treat conditions that conventional medicine does not recognize and to use sings for healing along with conventional medicine used curatively.~Numerous observers have asked why the sings "work." Topper (1987, p. 248) remarks that sings are restorative: "They restore an individual's ego functions and integrate the patient back into the social setting from which he or she has become estranged." Sandner (1979, 1991) analyzes the process further: First, the herbal remedies often have requisite physiological effects. Second, the patient's expectation is encouraged time and again during the chant by its intricate psychological structure. Third, the patient is socially supported by the entire community, who are centrally concerned since, by Navajo cosmology, the well-being of all is threatened by disharmony in one. Fourth, the chant wordings guide the sick person to finding culturally appropriate answers to difficult cosmological problems, such as the management of evil and the inevitability of death. Formal research into the healing ceremonies and herbal medicines conducted and used by bona fide Native American Indian healers or holy people is almost nonexistent, even though Native American Indians believe they positively cure both the mind and body. Ailments and diseases such as heart disease, diabetes, thyroid conditions, cancer, skin rashes, and asthma reportedly have been cured by Native American Indian doctors who are knowledgeable ~about the complex ceremonies. Among Native American Indians living today there are many stories about seemingly impossible cures that have been wrought by holy people. However, the information on what was done is closely guarded and not readily rendered to non-Native American Indian investigators. It has been suggested that if Congress restored religious freedom to Native American Indians, then collaborative research into Native American Indian healing and healing practices could be possible (Locke, 1993).