Although psychiatry brings tremendous value to the amelioration and treatment of mental distress and illness, at times it falls short in providing holistic care within a patient’s broader cultural framework. Traditional healing and medicine often offer a more comprehensive, patient-centered approach to mental health treatment, which can encompass a patient’s spiritual beliefs, cosmology, and world view. For certain patients, a combination of Western psychiatric treatment and traditional healing has significant potential to alleviate symptoms within the context of physical health, spiritual life, and social milieu. In some traditions, mental health is particularly relevant, cross-cutting various conceptualizations of symptoms and illnesses. Based on our experience, we share a model for psychiatrists interested in collaborating with traditional healing and medicine.
Our focus is on traditional medicine arising from a country’s indigenous cultures. We spotlight specific examples of North American indigenous healing traditions that figure importantly in our clinical and program experience with rural Native American veterans. Our purpose is to illustrate the possible synergies that promise greater benefit for these patients than either practice pursued independently.
The use of traditional medicine is found in cultures throughout the world, and it is often encountered by US psychiatrists working with immigrant and refugee populations. Incayawar and colleagues1 provide a number of specific examples of other cultures and conceptual models of collaboration between psychiatrist and traditional healers.
Traditional healing and mental health
The literature pertaining to traditional healing practices in mental health is largely descriptive and therefore is limited in its rigor by today’s scientific standards.1 Indeed, there is an active debate as to whether current Western scientific methods are appropriate for examining the nature, processes, and outcomes of traditional healing. Part of this debate revolves around a historical monopoly of the study of traditional healing by Western, nonindigenous researchers whose views typically lie outside the cultural perspectives that inform a particular healing tradition.2
The description of indigenous healing traditions in North America dates to the 1500s, when early European settlers began co-opting and adapting treatments with Native American traditional healing.3 The earliest reports from “modern” psychiatry date to the 1940s and are best illustrated by the Leightons’4 work on psychotherapeutic aspects of the Navajo religion. Since the 1940s, a rich body of literature augmented by more recent epidemiological research began to document the importance of concurrent use of biomedical and traditional healing among Native Americans across a diverse range of tribes.1,5-7 Gone8 described parallel therapeutic processes and the possibility of integrating Native American concepts and healing traditions into psychotherapy.
Several major themes have emerged. Among them are the importance of concurrent, rather than mutually exclusive, pursuit of biomedical and traditional healing, and the feasibility as well as benefit of combining these approaches as treatment for Native American patients.9 However, this literature is largely silent with respect to how clinicians can address these issues in their individual practices and programs.
Incorporating traditional healing in practice
The Table presents our model for incorporating traditional healing in psychiatric practice; 5 key components influence the successful inclusion of traditional healing:
• The psychiatrist
• The patient
• The Western system of care in which treatment takes place
• The traditional healing in the context of the community
• The traditional healer/practitioner
Dr Shore is Native Domain Lead at the Veterans Rural Health Resource Center—Western Region, Office of Rural Health, Department of Veterans Affairs, Salt Lake City, and an Associate Professor at the Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Denver, Aurora. Mr Richardson is Minority Veterans Program Coordinator for the VA Rocky Mountain Healthcare Network (VISN 19), Fort Harrison, Mont. Dr Bair is Director of the Veterans Rural Health Resource Center—Western Region, Office of Rural Health, Department of Veterans Affairs, Salt Lake City. Dr Manson is Director of the Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Denver, Aurora. The authors report no conflicts of interest concerning the subject matter of this article.
1. Incayawar M, Wintrob R, Bouchard L, eds. Psychiatrists and Traditional Healers: Unwitting Partners in Global Mental Health. London: Wiley-Blackwell; 2009.
2. Henderson J. Legitimacy and contextual issues in traditional Lakota Sioux healing. In: Incayawar M, Wintrob R, Bouchard L, eds. Psychiatrist and Traditional Healers: Unwitting Partners in Global Mental Health. London: Wiley-Blackwell; 2009:13-24.
3. Dary D. Frontier Medicine. New York: Random House; 2008.
4. Leighton AH, Leighton DC. Elements of psychotherapy in Navajo religion. Psychiatry. 1941;4:515-523.
5. Marbella AM, Harris MC, Diehr S, et al. Use of Native American healers among Native American patients in an urban Native American health center. Arch Family Med. 1998;7:182-185.
6. Buchwald D, Beals J, Manson SM. Use of traditional health practices among Native Americans in a primary care setting. Med Care. 2000;38:1191-1199.
7. Novins DK, Beals J, Moore LA, et al; AI-SUPERPFP Team. Use of biomedical services and traditional healing options among American Indians: sociodemographic correlates, spirituality, and ethnic identity. Med Care. 2004;42:670-679.
8. Gone JP. Psychotherapy and traditional healing for American Indians: exploring the prospects for therapeutic integration. Couns Psychol. 2010;38:166-235.
9. Shore JH, Shore JH, Manson SM. American Indian healers and psychiatrists. In: Incayawar M, Wintrob R, Bouchard L, eds. Psychiatrist and Traditional Healers: Unwitting Partners in Global Mental Health. London: Wiley-Blackwell; 2009:123-134.
10. Shore J, Kaufmann LJ, Brooks E, et al. Review of American Indian veteran telemental health. Telemed J E Health. 2012;18:87-94.
11. Kaufmann LJ, Richardson WJ Jr, Floyd J, Shore J. Tribal veterans representative (TVR) training program: the effect of community outreach workers on American Indian and Alaska Native veterans access to and utilization of the Veterans Health Administration. J Community Health. 2014;39:990-996.
12. Livingston R. Medical risks and benefits of the sweat lodge. J Altern Complement Med. 2010;16:617-619.
13. Department of Health and Human Services: Indian Health Service. Special General Memorandum 94-8. Indian Health Manual; 1994. http://www.ihs.gov/ihm/index.cfm?module=dsp_ihm_sgm_main&sgm=ihm_sgm_9408. Accessed May 5, 2014.