NAHO CONFERENCE

2009

OTTAWA, ON

Self-Esteem as a Culturally-Biased

Construct and Using of Narrative

Story-telling to enhance Resiliency

in First Nation Mental Health

Authors: Dr. Bob Chaudhuri (1), Melissa

Crawford, MED-3(1), Gerry V Martin,

Anishawbae(2).

Affiliations:

1. Northern Ontario School of Medicine

2. Thunder Bay, Traditional Teacher

Objectives:

To understand the Historical Conception and

Critique of Self-Esteem

To consider Self-Identity as an alternative

Method of Thinking about Self-Esteem

To explore Narrative or Art Therapy to Treat

First Nation Trauma

Ever since Antiquity, the concept of Self-Esteem or Pride [from the Latin, prodessemeaning “to be good or beneficial for the self”]

Before the Greeks, the Sumerians and Egyptians [circa 2100 and 1500 B.C. make reference to pride.]

However, it is Aristotle who speaks about pride and sets a standard, as life is unliveable without pride, commenting on the subject, commenting on false humility, hubris and vanity. However, his philosophical discussions omit women…

In Western thought, with the rise of the Church, Pride becomes a Sin, in fact one of the 7 Deadly Sins.

As Pride and Vanity became subjects to the Catholic concept of Sin when the Jesuits and Benedictines came to teach the “savage” Native Population example of haircutting of students with long braids and hair –styles (i.e. The Blackfoot Nation) was traumatic.

We come to 1890, the Social Darwinists, Freud and William James who essentially rename “pride” as “self-esteem”.

The masculine and feminine discrimination still exists, as Self-Esteem becomes subject to standards and “should” statements that differ between men who are “higher” and women who are “lower” beings.

Karen Horney, in the 1950s, on both concepts of pride and self-esteem, writes that the Real Self needs neither; though later she links inflated self-esteem with narcissism.

Bem, in the 1970s, started a self-rating scale for self-esteem involving socio-cultural ideals about men and women. Others followed with their own scales and as all of them were criticized, no one asked the basic question – what does low self-esteem really mean?

However, Bem in her memoirs in the late 1990s she admits to being surprised at how popular her view and scale became.

Rosenberg summarizes the uses of Self-Esteem to Sociability, Performance and Affect.

Mrurk, in 1995, summarizes four points about self-esteem:

1. it is complex often with contradictions

2. it can be related to both good and poor mental health

3. it has become a basic behavioural construct in trying to explain human behaviour

4. it may have social significance in understanding social problems

What does Culture have to do with this history of self-esteem when it comes to First Nation’s (FN) People? The statistics (NAHO, 2003):

– 1 out of 4 FN children lives in poverty

– 33% of FN children live in overcrowded homes

– Over 50% of FN children are obese or overweight

– The rate of FN children with disabilities is 1 in 8; this is double the Canadian rate

– 1 out of 6 Canadian children lives in poverty

– Direct correlation between lower family income, overcrowding, poor nutrition, lower levels of physical activity and educational achievement among FN children

– The cycle of poorer health and well-being of FN people is reflected in the RHS data

– Income and Education levels from the Present are linked to the Past and to Future Funding for the Next Generation

– Overcrowding is linked to income and education levels

– Overcrowding impacts education outcomes

– Educational level is linked to employment

– Double the Canadian average rate for suicide

– Mental health issues from depression to substance abuse etc…

These stats are almost seven years old and most likely have become more alarming for example, substance abuse has become more prevalent and with the apology from the federal government with respect to residential school trauma survivors have identified themselves more yet problems with inter-generational trauma, which affects Native youth/children the most, has also increased.

Given the dubious history of “Self-Esteem”, let us challenge the concept and perhaps generate a new paradigm to uncover a First Nation or Aboriginal sense of self-identity and re-discover origins and representations of their social suffering.

Indigenous people throughout the world, not just North America, have been exploited by colonial systems for several centuries. In Canada, the Residential school system was a method of instilling a pervasive sense of inferiority.

Cultural anxiety and maladaptive coping strategies that were defensive in nature have overcome the more vulnerable who have severe issues with their mental health.

Personal Suffering in any individual must be understood through the person as past, present and future; in terms of family, culture; as a socio-political being in relationships with others; as having regular behaviours, having a secret life and finally a spiritual or transcendent side beyond mind and body.

Cultivating that person’s “Self” through discovery is part of this Resiliency of Spirit.

Rethinking “Self-Identity”

For therapists to re-vitalize our efforts, a secure “Sense of Self” must be promoted. A healthy self-identity requires a good sense of self-worth and concept of who one is. Experiential and existential knowledge of oneself through knowledge of the Indigenous worldview, as divergent that it may be from community to community, is helpful, as are the processes of spirituality and healing. However, every individual is different.

Example 1:

One grows in a more negative environment as mentionedearlier. Because culture is a learned, experiential phenomenonthat begins at birth and can be modified by guides, schooling,professions or an impoverished upbringing without hope andbeing physically abused, self-silencing begins. This can leadto self-fragmentation and confusion centering around who oneis, should be. Add the stigma of the dominant culture towardsNative population and maladaptation occurs, via anxiety,depression, substance abuse and suicide. Those who make itto counselling get either pills or lessons in CBT about self-esteem, but the oldest tool in psychiatry, psychology, socialwork, nursing etc. is Active Listening and history-taking, andbeing patient: waiting for the story to emerge.

However, Indigenous health and

healing information and practices are

practically non-existent through the

mainstream health care system, which

is dominated by Western approaches.

Substance abuse such as, Oxycontin and

Percocet have taken over the current

Escape drug of choice.

Example 2:

The reverse situation, has the Native child brought by resilient parents, things aren’t always positive but self-expression and self-exploration is allowed and encouraged.

Self-integration can then begin leading to a healthy self-worth, concept and hopefully a strong identity.

But, even these cases are fraught with challenges as different familial links or that exploration into the past is traumatic, and lead to anxiety rather than cultural recovery

In both examples the young Native child, depending

on the supports that they get, can either become

secure about themselves and their sense of self or

have issues of insecurity surrounding who they are

and what they should do.

The child’s spirit of resiliency will be defined

somewhat as well by how it’s community responds to

poverty, violence, education, healthcare, and other

traditional Native practices.

Why use Narrative Therapy?

Storytelling and narrative traditions run deep within Aboriginal cultures. Artistic imagery and painting, wood-crafts and sculpture also run deep within this culture.

It should be used as a psychotherapeutic technique to try and interpret and learn more about a client in need. This type of relationship would initially have to be earned by meetings that were face-to-face using a trust relational modality through an interpreter.

This trust could take several visits before perhaps video-conferencing occurred. The aim is to take a client from self-silencing and confusion to self-expression, exploration and eventually a healthy sense of self.

This type of therapy can be non-linear as the client is in charge of the therapy and the therapist is merely a guide to help seek balance fro the client

This type of therapy may help front-line crisis workers in under-serviced areas with some basic prevention tools that they will need to be educated about, but they should also feel free to call someone in an emergency situation.

Mental health delivery to rural and remote regions for the Indigenous peoples of Canada is needed now more than ever. This novel modality can help, as it could become another tool in the therapist’s workbook using a traditional approach via story-telling and art as guides for the patient to tell us what works for them specifically, by looking at history in a more elaborate yet less intrusive manner. Trust relationship building with each community is key.

“Reality is that which, when you stop believing in,

doesn’t go away” - Phillip K. Dick

Many survivors of Residential schools, or their

offspring, are trying to find their way towards some

sense of self, yet wake to the trauma of their own

cultural anxiety daily. This paper is hopefully a

springboard for new ideas and treatments.

Questions?

Meegwetch, Nia:wen, Merci, Thank you