Healing Historical Trauma
Native American researchers are turning long-held traditions into novel public health solutions.
At age 6, Priscilla Agnes Morrisseau became number 332A.
It was the identification assigned to the little girl when she arrived at St. Margaret’s Indian Residential School in 1953. Forcibly removed from her family home on the Couchiching First Nation reserve in Fort Frances, Ontario, by Canada’s Department of Indian Affairs, she spent the next five years at the school run by the Catholic Church.
It was a brutal place, says the 74-year-old, now Priscilla Agnes Simard. She remembers coal oil treatments that burned her scalp to kill nits. The nuns beat her with a leather strap on the hands and back of the legs when she spoke her native Ojibwe or mispronounced English words. Meals were mainly watery stews preceded by doses of cod liver oil.
The school, located on the reserve, allowed Simard to return home on Sundays for a few cherished hours. She remembers her mother stroking her hair, cut short when she arrived at the school. “It was very, very soothing, and would last me for the week,” she recalls.
One particularly haunting recollection takes Simard back to the girls’ dorm filled with rows of steel beds with thin mattresses. She recalls a nun coming in the middle of the night and leaving with a girl or two, then returning with the children, who were crying.
“It never ever hit me until later on that I had witnessed some of the sexual abuse that was going on at the school,” says Simard. “In my mind today, I don’t even know if I was one of them. I can still hear their cries.”
Simard, who still lives in Fort Frances, although not on the reserve, is a third-generation survivor of Indian residential schools operated by the Canadian government from the 1870s to 1997. She is among more than 150,000 Indigenous children who were forced into such schools as a means of assimilating them into society.
In 2007, Canada took steps to confront the inhumane treatment at Indian residential schools, including a government apology, financial settlements for residential school survivors, and a Truth and Reconciliation Commission that took testimony from survivors and their families and created a national research center. Still, revelations of horrors at the boarding schools continue. Last year, ground penetrating radar identified more than 1,300 unmarked graves at four former Indian residential schools in Canada.
Although Simard left the residential school at 11, the painful memories remained fresh and have shaped her life. She depended on alcohol for many years to cope with the anger she buried. She also managed to build a productive life, marrying, raising two children, and holding down jobs. And she got sober at 35.
A critical part of her hard-fought recovery, she says, was reconnecting with her Native language and cultural traditions.
“That’s what the school took away from me,” says Simard. “That was my identity.”
Trauma Handed Down
Some 700 miles and a few generations distant, psychiatric nurse practitioner Joseph Ojibway too often witnesses the persistence of trauma that Simard battled with for a lifetime. He sees it in his patients at a Saginaw Chippewa Indian Tribe medical clinic in Mount Pleasant, Michigan.
“They’re coming in now as adults and often times they’re still struggling, whether it be with addiction, chronic depression, anxiety,” says Ojibway, MSN, PMHNP, the tribe's first and only psychiatric mental health nurse practitioner. “It’s a result of historical trauma that’s been built up and passed on and is just coming to the surface. They might not be fully aware that it’s related to the long lineage of suffering and experiences that their ancestors have gone through. But that’s how I recognize it.”
To get a sense of his patients’ experience with respect to trauma, he gives them a detailed intake form, which includes questions from the ACES (Adverse Childhood Experiences) survey, as well questions tailored to the community he serves, such as whether a relative attended an Indian boarding school.
Not one of his patients has ever scored zero on the survey.
Ojibway, whose great-grandfather attended the nearby Mount Pleasant Indian Industrial Boarding School, has learned that sharing a frame of reference with his patients helps to establish trust and open lines of communication. “When you have someone Native themselves step into the medical community saying it’s okay to talk about these things and not hold them in, having that trust is invaluable,” says Ojibway, who graduated from the Johns Hopkins School of Nursing last year.
Despite a deep connection with the Saginaw Chippewa community, Ojibway still runs into challenges. One of his patients is a young person whose legal guardian is a relative who attended a boarding school. Although Ojibway recommended counseling and medication to treat the patient’s symptoms, the guardian wouldn’t allow it. His reasoning, says Ojibway, is that he dealt with the boarding school experience himself and “got over it.”
“It’s a hard, heartbreaking situation that’s unfolding,” says Ojibway.
In the stories he hears and psychological effects he witnesses, he sees the undercurrent of historical trauma that has swept through Indigenous peoples in the U.S. just as in Canada.
A Cruel Mission
From 1869 to the 1960s, under U.S. policies supported by the Indian Civilization Act of 1819, it’s estimated that hundreds of thousands of Indigenous children were taken from their homes by government agents and sent to federally funded boarding schools. Precise numbers are elusive, but 60,000 children were forced into the boarding schools by 1925, according to the National Native American Boarding School Healing Coalition.
More than 350 schools in the U.S., mainly operated by churches and missionaries, were spread across 29 states. As in Canada, they aimed to “civilize” the students by erasing their Indian identity. The schools’ viciously distilled mission: “Kill the Indian in him, and save the man.” Records show that students’ lived reality included unimaginable physical, sexual, and emotional abuse.
There is a dearth of studies on the generational impacts related to boarding school attendance in the U.S., but Canadian research provides a window into the downstream effects of the experience. A 2018 Canadian paper, for example, found adolescents and adults who had a parent who attended a residential school are at increased risk for suicidal thoughts and attempts.
The Indian boarding school era is just one in a long line of atrocities in the United States’ treatment of Native Americans that include colonization, war, massacres, land seizures, forced assimilation, and relocation programs. The effects, supported by emerging research, course through Indigenous populations as historical trauma and surface in extreme health disparities compounded over generations.
In 2019, according to the U.S. Department of Health and Human Services’ Office of Minority Health, suicide was the second-leading cause of death for American Indian/Alaska Natives ages 10–34. AI/AN adults are almost three times more likely than white adults to be diagnosed with diabetes. The infant mortality rate among the AI/AN population is almost twice that experienced by whites.
“If you had to isolate one variable and go back with a magic wand and change things, for me it would be these indicators of historical trauma,” says Melissa Walls, PhD, MA, director of the Bloomberg School’s Center for American Indian Health’s Great Lakes Hub in Duluth, Minnesota. “Indigenous public health scholars would agree that the root cause of health problems that Native communities face has been the process of colonization. It’s historical only in that it started in the past; the enduring effects are still here.”
Maria Yellow Horse Braveheart introduced the concept of historical trauma in the Native American context in 1988, defining it as “cumulative emotional and psychological wounding over the lifespan across generations, emanating in massive group trauma.” Braveheart, PhD, MSW, an associate professor of psychiatry at the University of New Mexico, posited that collective unresolved grief—the historical trauma response—manifests in depression, anger, suicidal ideation, and other conditions. Other early research on historical trauma characterized the traumatic events as systemic and intentionally directed at a population, and likened the damage to a “soul wound.”
More contemporary forces—like underfunded government health care programs, relocation to cities, inadequate government food programs, and structural racism—have only led to worse health outcomes among Indigenous populations.
In a 2012 study, Walls examined the intergenerational fallout of the 1950s and ’60s relocation era, in which Indigenous people were encouraged to move to urban areas with promises of good jobs. Upon arrival, they often found the jobs to be seasonal work paying below minimum wage. Walls found that compared to families who did not relocate, the relocated group had a higher risk of alcohol misuse, which replicated in their children, who also showed elevated levels of depression. These factors contributed to poor parenting skills, which in turn impacted a third generation who showed increased levels of depression and unhealthy behaviors.
“In this one historical anchor and experience—and there are many [like it]—we can see ripple effects that hold up across three generations, which is a lot to ask of quantitative data and a lot to ask of imperfect measures of the experiences,” says Walls, a descendant of Bois Forte and Couchiching First Nation Anishinaabe.
Another federal government program—the Food Distribution Program on Indian Reservations—is implicated in high rates of obesity and kidney disease in Indigenous communities, says Donald Warne, MD, MPH, associate dean and director of Indigenous Health at University of North Dakota and a member of the Oglala Lakota tribe.
“Fried bread from commodity foods is not traditional,” Warne said in a recent talk at the Bloomberg School. “This is prepackaged diabetes that we’re dealing with right now.”
It is only over the past 20 years that Indigenous scholars have begun to develop more empirical evidence to understand poor health conditions through the lens of historical trauma. Central to this research are the Historical Loss Scale and Historical Loss Associated Symptoms Scale, developed in 2004. Their widespread use has shown that Indigenous people who have pervasive thoughts about cultural losses tend to have worse health outcomes.
A 2011 study of Indigenous communities in the U.S. and Canada, co-authored by Walls, found that frequent thoughts of historical losses—including loss of land and loss of family structure related to boarding schools—were associated with depressive symptoms among adolescents.
Reclaiming a Healing Culture
With so much taken from Indigenous peoples—not least their identity—Indigenous researchers are now drawing on long-held traditions to develop novel public health solutions.
“The health inequities that Native communities are experiencing are really in spite of us being Indigenous—not because of us being Indigenous,” says Walls, pointing to a culture that values extended family and emphasis on community over the individual. “There are so many great coping resources and cultural teachings that have survived because of Indigenous activism and resistance.”
The Center for American Indian Health is a leader in drawing on culturally based practices to develop programs that promote health and well-being in Indigenous communities. In Family Spirit, a home-visiting program launched in 1995, community health workers teach young families parenting skills; Culture Forward promotes cultural strengths and traditions to prevent youth suicide; and NativeVision, a sports and life skills program, aims to build self-esteem and healthy habits among youth.
Teresa Brockie, PhD, MSN, RN, an assistant professor at the Johns Hopkins School of Nursing, is leading a research project involving young families that combines lessons on intergenerational trauma with cultural practices. Growing up on the Fort Belknap Reservation in Montana as a member of the White Clay Nation, Brockie found inspiration in the Native public health nurses who served her community. She became a public health nurse herself and worked with Native populations in urban areas. One problem was glaringly apparent: “Interventions that have been developed for white, middle-class people wouldn’t necessarily work with us,” says Brockie, a core CAIH faculty member.
Brockie is doing her part to change that by infusing a public health program with Indigenous culture and history. Together with tribal partners, she created an intergenerational intervention called Little Holy One, based on the Fort Peck Assiniboine and Sioux Reservation, Montana. Targeting parents and their young children, the project incorporates lessons on Native American culture and historical trauma, as well as sessions on promoting parenting skills. A primary goal, she says, is to break cycles of trauma, substance use, and suicide by promoting resilience in families before children reach the adolescent years.
The program was born of a 2010 tragedy—a cluster of six youth suicides on the Fort Peck Reservation that prompted the tribe to declare a state of emergency. The next year, for her doctoral dissertation, Brockie sought to identify risk and protective factors related to youth suicide. In her study of 288 Fort Peck tribal members ages 15–24, she found an association between historical trauma and suicidal ideation and suicide attempts, and that tribal identity and group efficacy was associated with a lesser likelihood of high-risk substance use.
Informed by these findings, Brockie, in close partnership with the Tribal Advisory Board, developed cultural lessons for parents and children to take part in together. Activities include a naming ceremony to promote tribal identity and smudging, a spiritual practice of burning sacred herbs in clay bowls for prayer. A parents-only lesson on healing historical trauma focuses on resilience in Native people in the context of surviving past traumas.
Delayed by COVID-19, Little Holy One is now recruiting a cohort of 120 caregivers and children ages 3–5 from across the reservation, including from the Fort Peck Head Start program, for a randomized controlled trial.
“Although historical trauma has been part of our conversation over the past 20 years, there hasn’t been really strong or evaluated lessons or interventions,” Brockie says. “If we want to have an impact on Native communities, we need to recruit students and train people who are interested.”
That includes people like Joseph Ojibway, who is combining his academic training in physical and mental health care with spiritual traditions of the Saginaw Chippewa community.
“Depending on how you were raised as a Native person, I think that we feel more comfortable talking about spirituality,” he says. “When I walk into the clinic, the first thing that greets me is the smell of smudge, and you know something’s different here.”
Ojibway leads grief groups in a traditional teaching lodge on the reservation. He started with two adult groups and recently added a group for teens after the suicide last fall of a well-known young man devastated the community.
In the lodge, under an arched roof made of maple saplings, participants circle around a sacred fire that burns the four sacred medicines—tobacco, sage, sweet grass, and cedar. The groups have included mothers of children who died by suicide and friends of the young man who recently ended his life.
“When you have the sacred fire there in the center, and you’re able to offer up some of those traditional medicines, it is our direct connection to the Creator,” says Ojibway.
Working near where his great grandfather was housed in a boarding school is a “beautiful full circle” for Ojibway, who plans to raise his 18-month-old son around the culture that he didn’t grow up with.
“I feel like I’m doing something that I was meant to do,” he says.