I expected to experience much the same type of lifestyle while, as a medical student, I worked on a clinical rotation in the behavioral health department at the Pine Ridge Indian Health Service Hospital in South Dakota. What I found, though, was much different—children for whom life had become harsh, unpredictable, and scary. The family structure that historically had kept the children safe, in many instances had broken down. The tribal culture and social infrastructure that gave the family a foundation had begun to erode and was being replaced by drugs, violence, and gangs.
A 9-year-old boy I met, Sage, made me realize that multiple generations of lives have been altered because of the fragmentation of the community and family structure. He had been referred to Indian Health Service by his school because of conduct and behavior concerns. His heartbreaking story is made even more so by the fact it is not unique.
Wounded Knee
I arrived on the reservation and through the generosity of tribal members found a room in the little settlement of Wounded Knee, a few miles northeast of the town of Pine Ridge. Wounded Knee is famous in American history for the Massacre at Wounded Knee Creek in the winter of 1890, in which over 200 Miniconjou and Hunkpapa Lakota men, women, and children were killed by members of the US Seventh Cavalry.
In the aftermath of that massacre, an infant girl was found alive, shielded from the elements by her mother’s frozen body. She was named Zintkala Nuni (Lost Bird) and adopted by Brigadier General Leonard Colby, who then took her back East. He later abandoned his family while she was still a child. Lost Bird struggled to find a place of belonging and was expelled from several different schools. Eventually, she found work in a Wild West Show. In 1920, she died in poverty at the age of 29 in California. In recalling this story, I often found myself making parallels between Lost Bird’s journey and those of many of the children at Pine Ridge.
Porcupine school
On the second day of my rotation, I left the hospital in Pine Ridge early in the morning to go to the Porcupine school. An hour later, I arrived at a collection of brick and metal prefabricated buildings. I pulled into the dirt parking lot and went inside, where I handed the lady at the front desk the slip of paper on which was written the name of the child I had come to see. I was told he was in the detention room. I walked into the room and found Sage sitting at a low, round table, dressed in a white T-shirt and jeans, with his head down, resting on folded arms. In front of him was a piece of paper with large penciled blobs of dark circles made so forcibly that the paper had torn in several places.
The detention room teacher looked up and nodded toward him. I asked her what had happened. She said he was disruptive in class, disturbing other kids and at one point had gone around the room taking pictures off the walls. I knelt down beside him. Sage didn’t look up. I introduced myself and asked if we could talk for a while. He didn’t speak. I asked the teacher if there was some place where he and I could talk. She directed me to an empty office. When I asked if he would like to go there, he stood up, head still down. As we walked, I commented on drawings taped to the walls and asked if any were his. Without looking up, he shook his head no. He looked like many American Indian children I had grown up with—slight in build, as my grandmother would say, deep brown eyes, and short, spiky dark brown hair.
The office felt warm and inviting. A small table sat on one side under a window that looked into the hallway. On the table were paper and crayons. Sage sat with his head down. I again introduced myself and asked what had happened that morning. He still said nothing. I told him he wasn’t in trouble. I only wanted to know what had happened and how he felt so I could help. He shifted in his chair and looked up through the window into the hallway.
I picked out a crayon and began drawing. He slowly did the same. Without speaking, he made lines and curves that soon became evident were the beginnings of a car. I asked him if he liked to draw cars. He replied, “This is my brother’s car.” With some gentle questioning, Sage told me he had an older brother and older sister but he didn’t see them very often. He didn’t live with them; he lived with his grandmother. When I asked about his parents, he said his mother was in prison. He didn’t see her very often but had once gotten to visit her on his birthday. He didn’t know where his father was. I remarked that it must get lonely not having his brother, sister, mother, or father around. He became quiet and without interrupting his drawing nodded his head yes.
Sage was proud of his brother’s car. With a smile on his lips, he told me that his brother let him help fix the motor once. As he talked, with great detail he drew flames going down the side of the car and paid particular attention to getting the right number of spokes on the chrome wheels. I asked what kind of work his brother did. “He sells drugs,” he responded. There was no sense of secretness or shame in his voice. It was a matter of fact. I heard from those living on the reservation that drug activity, cultivated by gang presence, was pervasive and touched nearly every child’s life.
Over the next 3 weeks, Sage told me a life story that shocked me at times and saddened me deeply. He told me about sometimes going to “the cabin” to find his sister. I learned from others that “the cabin” was a well-known location where women sometimes exchanged sex for drugs. He told me about people he knew who had been shot or shot at. He told me that sometimes he stayed with his “Auntie” (a tribal term for an adult female who cares for a child). While there, her husband would come home drunk and beat her. In telling his story, Sage expressed little emotion. He only drew and talked as if telling me about his day at school. The only time I saw a glimmer of joy in him was when he talked about his nameless pet cat or his grandmother. The only time he became tearful was when he told me he was afraid his grandmother was going to die. He asked, “If she dies, who will take care of me?”
There were so many traumas in Sage’s young life. He had seen and experienced things no child should ever see or experience. His life mirrored what I saw in many other American Indian children during my stay at Pine Ridge, children at the crossroads of vulnerable childhood innocence and the assaulting realization of the complexity of their lives. He was fast approaching the fork in the road where he would decide, given the choices at hand, how to handle the fear, anger, and resentment of his life. What parts would survive the struggle—the emotionless storyteller talking about prison and drugs or the gentle, at times tearful, boy who loved his no-name cat and worried about life without his grandmother?
Reflections
Every morning I drove past the Wounded Knee Massacre site, where those killed lay buried in a mass grave. Each day carried more and more significance. The parallels with the saga of Lost Bird and the children of Pine Ridge 100 years later did not escape me.
Almost from the moment Lost Bird was taken from the massacre site at Wounded Knee, the journey of American Indian children was steered onto a path to strip them of their identities, sense of belonging, and sense of cohesiveness with their people. The web of safety woven from culture, language, and purpose was stripped away by policy and practice to be replaced in many American Indian communities with anger, fear, and desperation. The reverberations of these acts are astounding.
American Indian children in South Dakota make up about 15% of the child population yet account for 52.2% of all children in state foster care.1 Native American children are more likely than children of other races/ethnicities to be identified as victims of neglect, and Native American youth commit suicide each year at a rate roughly 2.5 times the rate for all youth.2,3
It is clear that something is broken. The work needed to repair the web of safety will be complex and will require thinking differently from Western views of identity and individuality. A Navajo or Cherokee, for example, will not tell you who he is by name but by clan. As psychiatry continues to encounter cultures distinct from its European genesis, it must adapt to incorporate these ideas in its theoretical framework if it is to be successful in working with these populations.
Lost Bird was reburied at Wounded Knee in 1991. Her life, like those of many Native American children after her, was full of uncertainty and questions, not belonging to the world of her birth or the world of her benefactor’s creation. I don’t know what the answers are to help Sage and other Native American children like him. What I do know is that any intervention must not focus only on the child, but must also involve the family and ultimately the tribe.
Sage would be about 13 or 14 now. Questions still linger in my mind. Is his grandmother alive and caring for him? Did he follow the path of his brother? What decisions did he make? Where is he today? Ultimately, I wonder if he is still alive.
