The Healthcare Trail of Tears

But my father also supported human rights, freedom and self-determination for all people, including Latino agricultural workers, Native Americans, and the millions of impoverished white men and women who were treated as second-class citizens. —

Martin Luther King III

Mental health in rural America is almost nonexistent and dispensed by the few professionals who work in these areas. Is this because there is no need or care is absent for those who live in these humble, widely separated areas?

Recently, I happened across a note from a rural area practitioner in mental health. She was asking a listserve of mental health professionals for some pharmaceutical guidance. What medication should she prescribe?

A young woman patient, Native American, had recently come to her office for help. The woman had had a miscarriage and was very upset since previously she had children without incident. Now, the woman was disturbed by intense, frequent panic attacks during the day, disrupting her entire family and leaving her in tears.

The mental health practitioner admitted that mental health care and normal healthcare, were spotty in her area and that Native Americans frequently don’t receive the evaluations and the medical testing that might be indicated by their medical presentation. In fact, the healthcare worker wasn’t familiar with the genetic disorder ultimately diagnosed.

Fortunately, the Native-American woman had been atypically referred to a clinic quite a distance away from her home, where she was tested and found to have a genetic disorder, MTHFR. This particular disorder has a range of indications where microemboli can cause miscarriage, stroke, and several other vascular problems.

In addition to the vascular problems which have been seen, there are psychological problems.

As both DNA methylation and folate are important in mental health, reduction of MTHFR activity or folate deficiency have been associated with an onset of several psychiatric diseases, schizophrenia, bipolar disorder, depression, autism, and ADHD.

In particular, stress-related psychiatric disorders have been noted “with a focus on major depressive disorder and posttraumatic stress disorder (PTSD).” The question arises here as to how this particular disorder should be treated since it is genetic in nature.

Are psychotherapeutic medications appropriate? It reveals a hole in the current understanding of psychiatric illnesses and their genesis.

The Plight of the Forgotten in America

Americans who fall at or below the poverty line suffer from a void of healthcare services. Where can they turn?

When there are few resources to provide direct mental health services in a community, local healthcare professionals may need to refer patients to facilities outside of the community. The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains the National Directory of Mental Health Treatment Facilities 2020, an online listing of federal, state and local government, and private facilities that provide mental health treatment services.

The “solution” begs yet another question; how do you get to these services if you don’t have the financial means to travel? In a land where technology has blossomed like a welcomed spring, the poor have been left wanting and Native Americans are treated as second-class citizens.

It began with an American genocide and the Trail of Tears.

President Andrew Jackson signs the Indian Removal Act, authorizing the Army to force Cherokee, Chickasaw, Choctaw, Creek, and Seminole tribes, including some of his former allies in the War of 1812, out of Georgia and surrounding states. This sets the stage for the Cherokee Trail of Tears and other forced relocation marches.

Estimates are that up to 4,000 Native people died on that perilous journey where they were uprooted from their homes and weren’t even allowed to prepare adequately for the trip. They were placed in undesirable parts of the country where resources were scarce and still are.

The Southern States where they had lived is not similar to the arid lands where they were forced to live on poorly served reservations.

The young woman who presented with daily panic attacks to that ill-informed clinician was from one of those who live on the reservations. Change for the better has come as slow as molasses in winter for these original keepers of our lands.

The plight of Native children has been no better than this woman’s experience with mental health. Previously, Native American children were sent to boarding schools away from their parents and it was here that the tragedy was shocking.

Even worse, the National Resource Center on Child Sexual Abuse (1990) cites evidence that many Native American children were sexually abused while attending boarding schools.

American Indian adolescents were much more likely to be diagnosed with AD/HD and substance abuse or substance dependence disorders. The rates of conduct disorder and oppositional defiant disorder were also elevated in the American Indian sample.

The intent of the move westward for these people had devastating effects.

A Tale of 20th Century Reservation Schooling

Two doctoral students I was mentoring received summer internships on a reservation. Eagerly, they anticipated what they would teach the children, lesson plans and field trips were outlined and packed away as they left for a summer of learning — or so they thought.

The emails I received depicted a land of broken alcohol bottles, puppies hanging from trees, and a school with a library that had not one book in it. The science lab was even worse; one broken beaker, and a Bunson burner that didn’t work. They were crestfallen, so they decided to remedy the situation.

The two ordered supplies with their own funds and asked peers for donations. But were stopped by the local council. It would be embarrassing for them to admit they had a school without supplies, so the students began a series of secret purchases.

Books and lab equipment were ordered and delivered to a post office miles away. The supplies were picked up and hidden in their quarters until they could be quietly introduced without fanfare. It was a summer to remember.

Questioning why there is so much alcoholism, suicide and physical abuse on reservations is an admission of ignorance.

According to a study from the National Institute of Justice, some 84 percent of American Indian and Alaska Native women have experienced violence in their lifetime, and more than half have endured this violence at the hands of an intimate partner. More than two-thirds of the women, or 66 percent, say they have been the victims of psychological aggression by a partner.

There is no hope, little motivation, and discrimination awaits outside their homelands. Has the United States contributed to the plight of the Native peoples and has it been perpetuated by current administrations?