Biomedical approach a poor fit with aboriginal views on health and healing

by Naomi Adelson, PhD
Associate Professor and Chair, Department of Anthropology, York University

One of the tasks of a medical anthropologist is to explore the ways in which what we consider to be normal, natural entities—like our bodies or our ideas about health and illness—are understood through and fundamentally reflect our relationship to our social, cultural and political worlds.

Medical anthropologists examine the ways in which people make sense of health and illness in their everyday lives. We study health as more than the absence of disease, but also how it is interpreted through cultural valuations of well-being as well as through broader economic, social and political contexts.

The mainstream medical health care system emerges from its own specific historical context.

In Canada, and specifically in the context of First Nations Canada, over a century of internal colonial governance has profoundly shaped the relationship between medical professionals and First Nations, Inuit or Métis peoples and communities. The result of that history is that too often medical priorities are not in line with local aboriginal needs or priorities (Browne, Fiske and Thomas 2000; Smylie 2000).

It is therefore not surprising that when the Assembly of First Nations (AFN) advocate for the improved health of Aboriginals in Canada, they define well-being as the balanced intersection of physical, social and political health (www.afn.ca).

There are vast cultural, linguistic and social differences between First Nations across Canada—differences in gender and age; differences between those who live in urban, rural and remote regions; distinctions between those who are employed or unemployed; actor or rap singer; university professor or a full-time hunter; as well as differences in treaty-related rights and resources, and nation-based differences in levels of political autonomy.

While all of these factors play a role in the relative health of First Nations communities and individuals, two key elements that bring them together are their autochthonous status on this land and the subsequent disempowering relationship that far too many Aboriginal people and communities continue to have with the settler nation-state.

This relationship can and does affect the perspective many Aboriginals have about the health care system as part of a broader legacy of disempowerment—described in one study as resulting in feeling as though they and their health concerns were dismissed, trivialized or misinterpreted.

If the cultural nuances of interpersonal communication are also misread or dismissed, this can further lead to feelings of vulnerability or embarrassment (Browne, Fiske and Thomas 2000).

The illness experience of an aboriginal patient is interpreted not only through prior encounters within the health care system, but also through a worldview that might best be expressed through the indigenous ideals of holism, balance and respect.

Thus, even with the range of diversity amongst and between Aboriginal peoples across Canada, these three common, inter-related themes can sometimes underlie the process through which people express a sense of self, in both sickness and health, and in relation to others.

The contrast between this holistic worldview and a biomedical perspective can pose a challenge to an effective exchange between clinician and patient (Svenson and Lafontaine 1999).

The biomedical model presumes a passive and compliant patient for whom treatments are prescribed. This kind of compliance can be interpreted as yet another mode of disempowerment, despite the goodwill of the clinician.

The aboriginal wellness model moves away from this healer/patient dyad and toward a more comprehensive understanding of the individual in contexts beyond the formalized biomedical environment.

Aboriginal wellness involves the physical, emotional, mental and spiritual aspects of a person, and always in connection to his or her family network and community.

Unfortunately, this model of healing or concept of health priorities doesn’t normally translate across the boundary of care in a medically-based health care facility. If health care workers are non-Aboriginal, they are at a particular disadvantage in that they are often only able to communicate through the language and culture of biomedicine.

Thus many concepts, issues and practices do not traverse the linguistic, cultural, or social divide between the care giver and his/her patient (Svenson and Lafontaine 1999).

There can also be added social and economic issues that can further increase the distance between First Nations patients and non-Aboriginal health care workers (Samson 2003).

Cross-cultural sensitivity is nothing new, but it is also not enough. What requires innovation today is the way in which we shift our focus to the First Nation, Inuit or Métis individual as a member of a complex, diverse, expanding, yet historically-rooted cultural network.

When First Nations communities point to unemployment, excessive alcohol consumption, drug abuse, family or sexual violence and suicide as their primary social health concerns, there is, without doubt, a need to “rethink the applicability of different models of intervention from the perspective of local community values and aspirations.” (Kirmayer et al 2000: 613; RCAP 1996).

Resources and suggested readings
1. Browne, A., J. Fiske and G. Thomas. First Nations Women’s Encounters with Mainstream Health Care Services and Systems. Vancouver: Centre of Excellence for Women’s Health. 2000.
2. Kirmayer, L.J., G.M. Brass and C.L. Tait. “The Mental Health of Aboriginal Peoples: Transformations of Identity and Community,” Can J Psychiatry 2000; 45(7):607-616.
3. Royal Commission on Aboriginal People (RCAP). Volume 5, Renewal: A Twenty Year Commitment. Ottawa: Minister of Supply and Services. (http://www.ainc-inac.gc.ca).
4. Smylie, J. “A Guide for Health Care Professionals Working with Aboriginal Peoples,” SaGC Policy Statement. Journal SaGC. 2000.
5. Samson, C. A Way of Life that Does not Exist. Newfoundland. ISER. 2003.
6. Svenson, K. and C. Lafontaine. Ch. 6: The Search for Wellness. First Nations and Inuit Regional Health Survey National Report. First Nations and Inuit Regional Health Survey National Report Steering Committee. 1999. (http://16016.vws.magma.ca/firstnations/english/pdf/key_docs_7.pdf).

Naomi Adelson is an associate professor of medical anthropology at York University. Her research interests stem from a theoretical focus on the naturalization of social trauma. She has worked since 1989 with the Cree of northern Quebec on conceptualizations of health, stress and social suffering, and is a co-investigator with the CIHR-funded National Network for Aboriginal Mental Health Research and Training.

© Copyright 2007. Canadian Psychiatry Aujourd’hui. All rights reserved.

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